Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.200107
Jornal Vascular Brasileiro
Review Article

Tromboembolismo venoso em pacientes COVID-19

Venous thromboembolism in COVID-19 patients

Fabio Henrique Rossi

Downloads: 0
Views: 47

Resumo

Resumo: A Covid-19 é uma doença respiratória potencialmente grave causada pelo RNA vírus SARS-CoV-2, que apresenta risco aumentado de tromboembolismo venoso (TEV). Sua fisiopatologia está relacionada a processo inflamatório exacerbado e a coagulopatia associada, verificada pelo aumento do D-dímero, do fibrinogênio e dos produtos da degradação da fibrina. Sua ocorrência deve ser monitorada, prevenida e tratada de acordo com as recomendações e diretrizes existentes. Devido a sua associação com as formas mais graves da doença e morte, alguns grupos vêm propondo uma conduta profilática e terapêutica mais agressiva. Entretanto, não existe uma definição quanto ao risco-benefício desse tipo de conduta, devendo ser avaliada individualmente e de forma multidisciplinar. Neste estudo, revisamos os principais estudos e evidências disponíveis até o momento sobre o diagnóstico, profilaxia e recomendações de tratamento do TEV em pacientes COVID-19.

Palavras-chave

COVID-19, SARS-CoV-2, trombose, anticoagulante, coagulação intravascular disseminada, profilaxia

Abstract

COVID-19 is a potentially serious respiratory disease caused by the SARS-CoV-2 virus that involves an increased risk of venous thromboembolism (VTE). Its pathophysiology is apparently related to an exacerbated inflammatory process and coagulopathy, verified by an increase in D-dimer, fibrinogen, and fibrin degradation products. Occurrence must be monitored, prevented, and treated according to existing recommendations and guidelines. The increased risk of thrombosis, and the association between this phenomenon and the most severe forms of the disease and death have prompted some groups to propose a more aggressive prophylactic and therapeutic approach. However, the risk-benefit profile of this type of conduct has not been defined and cases must be assessed individually, with a multidisciplinary approach. In this study, we review the main studies and evidence available to date on diagnosis, prophylaxis, and treatment of venous thromboembolism in COVID-19 patients.

Keywords

COVID-19; SARS-CoV-2; thrombosis; anticoagulant; disseminated intravascular coagulation; prophylaxis

References

1 Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. http://dx.doi.org/10.1016/S0140-6736(20)30183-5. PMid:31986264.

2 Chen N, Zhou M, Dong X, et al. L. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. http://dx.doi.org/10.1016/S0140-6736(20)30211-7. PMid:32007143.

3 Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-7. http://dx.doi.org/10.1111/jth.14768. PMid:32073213.

4 Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost. 2020;18(7):1559-61. http://dx.doi.org/10.1111/jth.14849. PMid:32302453.

5 Ulhaq ZS, Soraya GV. Interleukin-6 as a potential biomarker of COVID-19 progression. Med Mal Infect. 2020;50(4):382-3. http://dx.doi.org/10.1016/j.medmal.2020.04.002. PMid:32259560.

6 Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. http://dx.doi.org/10.1016/S0140-6736(20)30566-3. PMid:32171076.

7 Xie Y, Wang X, Yang P, Zhang S. COVID-19 complicated by acute pulmonary embolism. Radiol Cardiothorac Imaging. 2020;2(2):e200067. http://dx.doi.org/10.1148/ryct.2020200067.

8 Klok FA, Kruip MJHA, Van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145-7.; Epub ahead of print. http://dx.doi.org/10.1016/j.thromres.2020.04.013.

9 Schünemann HJ, Cushman M, Burnett AE, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv. 2018;2(22):3198-225. http://dx.doi.org/10.1182/bloodadvances.2018022954. PMid:30482763.

10 ISICEM. The 40th International Symposium on Intensive Care & Emergency Medicine: Brussels, Belgium. 24-27 March 2020. Crit Care. 2020;24(Suppl 1):87. http://dx.doi.org/10.1186/s13054-020-2772-3. PMid:32209112.

11 Cronin M, Dengler N, Krauss ES, et al. Completion of the Updated Caprini Risk Assessment Model (2013 Version). Clin Appl Thromb Hemost. 2019;25:1076029619838052. http://dx.doi.org/10.1177/1076029619838052. PMid:30939900.

12 Thachil J. The versatile heparin in COVID-19. J Thromb Haemost. 2020;18(5):1020-2. http://dx.doi.org/10.1111/jth.14821. PMid:32239799.

13 Spyropoulos AC, Levy AH, Ageno W, et al. Scientific and Standardization Committee Comunication: clinical guidance on the diagnosis, prevention and treatment of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 2020;18(8):1859-65. http://dx.doi.org/10.1111/jth.14929. PMid:32459046.

14 The COVID-19 Sub-Committee of the American Venous Forum. Considerations in prophylaxis and treatment of VTE in COVID-19 patients. Illinois: American Venous Forum; 2020 [citado 2020 jun 15]. https://www.veinforum.org/wp-content/uploads/2020/04/COVID-19-White-Paper-04-17-2020-FINAL-1.pdf

15 Dolhnikoff M, Duarte-Neto AN, Monteiro RAA, et al. Pathological evidence of pulmonary thrombotic phenomena in severe COVID-19. J Thromb Haemost. 2020;18(76):1517-9. PMid:32294295.

16 Carsana L, Sonzogni A, Nasr A, Rossi R, Pellegrinelli A et al. Pulmonary post mortem findings in a large series of COVID-19 cases from Northern. medRxiv. 2020. http://dx.doi.org/10.1101/2020.04.19.20054262.

17 Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061. http://dx.doi.org/10.1001/jama.2020.1585. PMid:32031570.

18 Lippi G, Favaloro EJ. D-dimer is associated with severity of coronavirus disease 2019: a pooled analysis. Thromb Haemost. 2020;120(5):876-8. http://dx.doi.org/10.1055/s-0040-1709650. PMid:32246450.

19 Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18(5):1094-9. http://dx.doi.org/10.1111/jth.14817. PMid:32220112.

20 Chen J, Chen J, Wang X, et al. Findings of acute pulmonary embolism in COVID-19 patients. Lancet. 2020. In press.

21 Grillet F, Behr J, Calame P, Aubry S, Delabrousse E. Acute Pulmonary Embolism Associated with COVID-19 pneumonia detected by pulmonary CT angiography. Radiology. 2020;296(3):e186. http://dx.doi.org/10.1148/radiol.2020201544.

22 Spyropoulos AC, Lipardi C, Xu J, et al. Modified IMPROVE VTE Risk score and elevated D-dimer identify a high venous thromboembolism risk in acutely ill medical population for extended thromboprophylaxis. TH Open. 2020;4(1):e59-65. http://dx.doi.org/10.1055/s-0040-1705137. PMid:32190813.

23 Cohen AT, Spiro TE, Büller HR, et al. Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N Engl J Med. 2013;368(6):513-23. PMid:23388003.

24 Spyropoulos AC, Lipardi C, Xu J, et al. Improved benefit risk profile of rivaroxaban in a subpopulation of the MAGELLAN study. Clin Appl Thromb Hemost. 2019;25:1-9. http://dx.doi.org/10.1177/1076029619886022. PMid:31746218.

25 Sobreira ML, Marques MA. A panaceia dos anticoagulantes na infecção pela COVID-19. J Vasc Bras. 2020;19:e20200063. http://dx.doi.org/10.1590/1677-5449.200063.
 


Submitted date:
06/15/2020

Accepted date:
07/21/2020

5f8f23960e8825052f0c62b5 jvb Articles

J Vasc Bras

Share this page
Page Sections