COVID-19 Enfeksiyonu Olan Hastalarda Koagülasyon Sistemi Bozuklukları

Çin’de Şiddetli Akut Solunum Yetmezliği Sendromu-Coronavirus-2’nin (SARS-CoV-2) neden olduğu COVID-19 enfeksiyonu tüm dünya çapında bir pandemiye yol açmıştır. Ölüm oranı %4.3-14.6 arasında değişmekle birlikte, çalışmalar koagülasyon disfonksiyonunun ağır COVID-19 enfeksiyonu olan hastalarda önemli bir ölüm nedeni olduğunu ortaya koymuştur. Ağır hastaların çoğunda altta yatan bir hastalık (diyabet, kardiyovasküler hastalık, hipertansiyon) vardır ve başlangıçta solunum yetmezliği ortaya çıkar, ancak bazıları çoklu organ disfonksiyonuna neden olan sistemik hastalığa ilerler. Bu yazıda COVID-19 enfeksiyonu olan hastalardaki koagülasyon sistemi bozuklukları tartışılmaktadır.

Coagulation System Abnormalities in Patients With COVID-19 Infection

COVID-19 infection caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) in China led to apandemic all over the world. Although mortality rate between 4.3% to 14.6%, studies have shown that coagulationdysfunction is a major cause of death in patients with severe COVID-19 infection. The majority of the severely ill patientshave underlying disease (i.e. diabetes, cardiovascular disease, hypertension) and initially present with respiratoryinsufficiency but some of them progress to systemic disease causing multiple organ dysfunction. This manuscriptreviews coagulation system abnormalities in patients with COVID-19 infection.

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1. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507-13.
2. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
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;18:844-7.
4. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020 Mar 13:e200994.Doi:10.1001/ jamainternmed.2020.0994.
5. Fogarty H, Townsend L, Cheallaigh CN, Bergin C, Loeches IM, Browne P, et al. COVID-19 Coagulopathy in Caucasian patients. Br J Haematol 2020;189:1044-9.
6. Chousterman BG, Swirski FK, Weber GF. Cytokine storm and sepsis disease pathogenesis. Semin Immunopathol 2017;39:517– 28.
7. Iba T, Levy JH. Inflammation and thrombosis: roles of neutrophils, platelets and endothelial cells and their interactions in thrombus formation during sepsis. J Thromb Haemost 2018;16:231-41.
8. Iba T, Levy JH, Wada H, Thachil J, Warkentin TE, Levi M, et al. Differential diagnoses for sepsis-induced disseminated intravascular coagulation: communication from the SSC of the ISTH. J Thromb Haemost 2019;17:415-9.
9. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061-9.
10. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054-62.
11. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020:30;382:1708-20.
12. Ranucci M, Ballotta A, Di Dedda U, Bayshnikova E, Poli MD, Resta M, et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J Thromb Haemost 2020. doi: 10.1111/jth.14854.
13. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020;135:2033-40.
14. Fox SE, Akmatbekov A, Harbert JL, Li G, Brown JQ, Heide RSV. Pulmonary and Cardiac Pathology in Covid-19: The First Autopsy Series from New Orleans. medRxiv 2020.04.06.20050575; doi: https://doi.org/10.1101/2020.04.06.20050575.
15. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020;395:1417-8.
16. Klok FA, Kruip M, van der Meer NJM, Arbous MS, Gommers DJ, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020;191:145-7.
17. Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost 2020 doi:10.1111/jth.14830.
18. Song JC, Wang G, Zhang W, Zhang Y, Li WQ, Zhou Z, et al. Chinese expert consensus on diagnosis and treatment of coagulation dysfunction in COVID-19. Mil Med Res 2020;7:19. doi: 10.1186/ s40779-020-00247-7.
19. Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost 2020;18:1023-6.
20. 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;18:1094-9.
21. Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID -19. Thromb Res 2020;191:145-7.
22. Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res 2020;191:9-14.
23. Iba T, Arakawa M, Ohchi Y, Arai T, Sato K, Wada H, et al. Prediction of Early Death in Patients With SepsisAssociated Coagulation Disorder Treated With Antithrombin Supplementation. Clin Appl Thromb Hemost 2018:24:145S-9S.
24. Wang J, Hajizadeh N, Moore EE, McIntyre RC, Moore PK, Veress LA, et al. Tissue Plasminogen Activator (tPA) Treatment for COVID‐19 Associated Acute Respiratory Distress Syndrome (ARDS): A Case Series. J Thromb Haemost 2020 Apr 8:10. doi:10.1111/jth.14828.
25. Hadem J, Hafer C, Schneider AS, Wiesner O, Beutel G, Fuehner T, et al. Therapeutic plasma exchange as rescue therapy in severe sepsis and septic shock: retrospective observational singlecenter study of 23 patients. BMC Anesthesiol 2014;14:24. doi: 10.1186/1471-2253-14-24.
26. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü COVID-19 (SARS-CoV-2 Enfeksiyonu) Rehberi. 12 Nisan 2020, 64-68.