严重患有COVID-19的患者可能表现出高凝血能力,尽管升级了抗凝血治疗
Soslan Shakhidzhanov1,2, Anna Filippova1,2, Elizaveta Bovt1,2
1Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, 117997 Moscow, Russia.
Journal of clinical medicine
|March 27, 2025
概括
升级抗凝药在许多重病COVID-19患者中未能预防高凝性,增加了血栓形成和死亡的风险. 血栓动力学和D-二次体可以帮助评估这些风险.
科学领域:
- 内部医学 内部医学
- 血液学 血液学 血液学
- 传染性疾病 传染性疾病
背景情况:
- 接受预防性抗凝血治疗的重病COVID-19患者面临高血栓形成和死亡率.
- 升级的抗凝剂量并不能始终降低死亡率,并且对血栓形成有不确定的影响.
- 升级抗凝剂未能预防COVID-19患者的血栓形成和死亡的原因尚不清楚.
研究的目的:
- 为了调查升级抗凝剂是否有效地预防严重疾病的COVID-19患者的高凝性.
- 确定高凝血,炎症和临床结果 (血栓塞,死亡) 之间的关联.
- 评估血栓动力学和D-二次体对血栓事件和死亡率的预测价值.
主要方法:
- 对3860名COVID-19患者进行的前性多中心研究,其中包括1654名重病患者.
- 患者接受了不同剂量的肝素;通过激活的部分血栓形成时间 (APTT),D-二次体和低谷抗凝血中的血栓动力学来监测凝血.
- 主要结局:通过血栓动力学检测到的高凝血能力.
主要成果:
- 升级抗凝药未能在28.3%的重病患者中预防高凝性.
- 高凝血患者表现出更高的炎症标志物和更好的肌素清除.
- 血栓动力学检测到的高凝血性增加了1.68倍的死亡风险和3.19倍的血栓形成风险.
- 升高的D-二次体也与较高的血栓形成和死亡风险相关;缩短的APTT没有.
- 结合血栓动力学和D-二次体改善了对血栓事件和致命结果的预测准确性.
结论:
- 血栓动力学可靠地检测COVID-19患者的高凝血能力.
- 血栓动力学和D-二次体可以评估重病患者的血栓形成和死亡风险.
- 在一些严重炎症和良好的肌素清除的重症患者中,肝素的低谷效应可能不足以预防血栓形成,即使剂量增加.
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