Novi aspekti primene antikoagulantne terapije kod COVID-19 pacijenata - od profilakse do terapije komplikacija

Abstract

COVID-19 patients have a high risk of thrombosis of the arterial and venous systems due to extensive systemic inflammation, platelet activation, endothelial dysfunction, and stasis. D-dimer is an important prognostic marker of mortality caused by COVID-19 patients and its increased values indicate tissue damage and inflammation. The incidence of venous thromboembolism (VTe) is between 16 and 49% as a complication of more severe forms of COVID-19 infection in patients hospitalized in intensive care units. Prophylactic doses of low molecular weight heparin (lMWH) should be given to all hospitalized patients with COVID-19 infection in the absence of active bleeding. The safest way is to adjust the low molecular weight heparin (lMWH) dose according to body weight, especially in obese patients. Unfractionated heparin (UFH) is used in patients with a creatinine clearance of less than 30 ml/min. The therapeutic dose of anticoagulation should be discontinued if the platelet count is <50 × 109 /l or fibrinogen <1.0 g/l. Clinically significant bleeding events are higher in those who received therapeutic doses compared to those with standard thromboprophylaxis doses. Thrombolytic therapy is recommended in patients with proven pulmonary embolism (Pe) and hemodynamic instability or signs of cardiogenic shock, who are not at high risk of bleeding. In hospitalized COVID-19 patients with a high clinical risk of developing venous thromboembolism (VTe) and D-dimer values greater than 2600 ng/ml, the use of therapeutic doses of lMWH in doses adjusted to the patient's body weight should be considered, in the absence of a higher risk of bleeding.