| کلیدواژههای انگلیسی مقاله |
COVID-19, blood coagulation disorder, venous thromboembolism, CVA, acute coronary syndrome, What&,rsquo s Known Since the emergence of the COVID-19 pandemic, an increasing number of reports and studies have tried to warn the medical community about the thrombotic complications of CVOID-19. It is suggested that the hyperinflammatory response and endothelial injury, especially in patients with severe disease, lead to a hypercoagulable state. What&,rsquo s New COVID-19 increases the risk of thrombotic complication via induction of a hypercoagulable state. In the absence of contraindications, thromboprophylaxis with at least standard-dose low-molecular-weight heparin is recommended by major societies for all severely or critically ill hospitalized patients. Antiplatelets should not be used to prevent thrombotic complications. Hypercoagulopathy may temporarily continue after the acute phase of the illness thromboprophylaxis extension may be considered in patients who were critically ill. IntroductionIn late December 2019, cases of a presumably novel viral pneumonia emerged from Wuhan city in Hubei Province, China, which immediately spread to other countries and caused numerous cases of acute respiratory failure and massive consumption of healthcare resources. Soon a novel member of the Coronaviridae family, later called &,ldquo severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)&,rdquo , was identified as the etiology of this outbreak, and the disease from the virus was generally termed &,ldquo COVID-19&,rdquo . Later, on March 11th, World Health Organization declared the COVID-19 outbreak as a pandemic. SARS-CoV-2, a single-stranded RNA virus, contains spike proteins on its envelope, that attach to a complex of host cell membrane proteins, in which angiotensin-converting enzyme 2 (ACE2) and transmembrane protease, serine 2 (TMPRSS-2) are the major cell entry elements. 1, ACE2 is highly expressed in type II pneumocytes and enterocytes, followed by the proximal tubules of renal nephrons, vascular endothelia, brain, the cholangiocytes of the liver, and the bone marrow. Almost all tissues express this protein. 2, As mentioned above, endothelial cells express ACE2 and may protect against viral invasion. The probability of endothelial inflammation gives rise to the hypothesis that diffuse thrombosis and ischemia in the microvascular bed of organs may be implicated in the rapid deterioration of some patients. 3,- 5, Moreover, significantly higher viral RNA titers have been identified in the kidneys, livers, and hearts of more than 40% of deceased patients. 6, Still, despite the vast expression of ACE2 in the human body, the cytokine release syndrome (CRS) is the number one suspected mechanism for multiorgan failure in patients with severe disease, not the direct invasion of organs by the virus itself. 7,, 8, Whether the multiorgan failure is because of CRS or diffuse ischemia, or both, is unclear. However, it is speculated that through similar signaling pathways, viral invasion, and CRS both lead to endothelial injury, and the release of coagulation factors, eventually leading to a hypercoagulable state. 9, Another finding that suggests fulminant cardiovascular events is the occurrence of sudden deteriorations and deaths among patients. 10, To date, the optimum dosage of low-molecular-weight heparin (LMWH) for thromboprophylaxis purposes in patients with COVID-19 has not been designated, and many experts call for high-quality clinical trials. There is an increase in the incidence of thrombotic complications even among patients receiving standard-dose thromboprophylaxis. 11,, 12, In this study, we review the evidence regarding thrombotic complications and their probable pathophysiology and present the current recommendations for the prophylaxis and treatment of such complications. We do realize that these recommendations are mostly expert opinions and maybe revised by upcoming high-quality studies. A Rapid Review of the Clinical Experience and ObservationsThere has been a surge in thrombotic complications affecting both intensive care unit (ICU) and non-ICU COVID-19 inpatients. 13,, 14, A postmortem study of 12 inpatients demonstrated the presence of deep vein thrombosis (DVT) in 58%, and PE as the direct cause of death in 25% of patients. 6, There are numerous reports of unexpected thrombotic complications, some of which are summarized in table 1,. AuthorsDemographicsRisk Factor(s)Complication(s)Management and Outcome Martinelli and others15,A 17-year-old Italian womanPregnancy (29th week of gestation) and obesityPE and Staphylococcus aureus septicemiaSurvival and emergent delivery of the fetus via caesarian section, followed by anticoagulationGiacomelli and others16,A 67-year-old Italian manAbdominal aortic prosthetic graft six years earlierThrombosis of the aortic graftDeathBaldacini and others17,A 62-year-old Italian woman Undiagnosed acute promyelocytic leukemiaRecurrent CVAs and DICDeathLe Berre and others18,A 71-year-old French manProminently elevated D-dimer levels DVT, PE, and aortic thrombosisSurvival and conservative management with enoxaparinUllah and others19,A 59-year-old American womanHypertension, diabetes, and elevated D-dimer levelsPE and right ventricular failureSurvival and conservative management with enoxaparinde Barry and others20,A 79-year-old French womanNone Thrombosis in the superior mesenteric artery and veinDeath Oxley and others21,A series of 5 American patients younger than 50 years oldTwo patients had no risk factors, one had hyperlipidemia and hypertension, and two had diabetes (one of these two patients also had a prior stroke)CVAOne patient was admitted to the ICU and four patients were discharged.Endovascular intervention, antiplatelets, and anticoagulants |
| نویسندگان مقاله |
Leili Pourafkari |
Catholic Health System, University at Buffalo, Buffalo, NY, USA
Mohammad Mirza-Aghazadeh-Attari |
Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
Medical Radiation Sciences Research Group, Faculty of Medicine, Tabriz University
Armin Zarrintan |
Medical Radiation Sciences Research Group, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
Department of Radiology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
Seyed Ali Mousavi-Aghdas |
Medical Radiation Sciences Research Group, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
Student Research Committee, Tabriz University of Medical Sciences, Tabriz
Aging Research Institute, Tabriz University
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