Pulmonary Intravascular Coagulation Pathogenesis in COVID-19 and Treatment Recommendations

Yıl 2020, Cilt: 3 Sayı: S1, 106 - 110, 15.05.2020

Faik Sarıalioğlu Fatma Burcu Belen Apak

Öz

It has been recently shown that the activation of the coagulation system takes an important part in the pathogenesis of COVID-19. It has come into insight that the mortality rate is lower in patients who were administered low molecular weight heparin (LMWH) during the course of COVID-19 when compared with those who were treated without LMWH. However, we observe that the coagulopathy accompanying COVID-19 seems to be different from sepsis associated disseminated intravascular coagulation (DIC), therefore we think that organ specific coagulopathy should be better named ‘Pulmonary Intravascular CoagulationPIC’. Here we provide possible pathogenetic mechanisms underlying COVID-19 including PIC and give treatment recommendations as administration of prophylactic LMWH at patients with increased D-dimer levels at early phase, escalation to treatment dose of LMWH in case of increasing D-dimers and usage of tPA or defibrotide with evaluation of bleeding risk in patients with respiratory insufficiency. However, in what point of COVID-19 disease shall those anticoagulant/antitrombotic-thrombolytic agents used must be evaluated with further studies.

Anahtar Kelimeler

COVID-19, pulmonary intravascular coagulation (PİC), low molecular weight heparin, tissue plasminogen activator (tPA), defibrotide

COVID-19 Patogenezinde Pulmoner İntravasküler Koagülasyon ve Tedavi Önerileri

Öz

Tüm dünyayı ve ülkemizi etkisi altına alan COVID-19 hastalığının patogenezinde koagülasyon sisteminin aktive olmasının önemli rolü olduğu, dissemine intravasküler koagülasyonun (DİK) laboratuvar bulgularından D-dimer değeri yüksek olan olgulara erken dönemde düşük molekül ağırlıklı heparin (DMAH) başlanması durumunda mortalitenin azaldığı bilinmektedir. COVID-19 enfeksiyonundaki ana mekanizmalardan birinin sepsis ilişkili DİK’ten farklı organa özgü ‘Pulmoner İntravasküler Koagülasyon-PİK’ olduğunu düşünmekteyiz. Patogenetik mekanizmaları açıkladığımız derlememizde PİK erken dönemlerinde profilaktik dozda DMAH, D-dimer artışı devam etmesi durumunda tedavi dozunda DMAH, respiratuar yetmezlik gelişmesi durumunda kanama riski göz önünde bulundurularak doku plazminojen aktivatörü (tPA) ve defibrotid tedavilerinin kullanımı konusunda tedavi önerileri yer almaktadır. Bu tedavilerin COVID-19 enfeksiyonunun hangi aşamalarında kullanılmasının uygun olacağının netleştirilmesi için klinik araştırmalara gerek duyulmaktadır.

Anahtar Kelimeler

COVID-19, pulmoner intravasküler koagülasyon (PİK), düşük molekül ağırlıklı heparin (DMAH), doku plazminojen aktivatörü (tPA), defibrotid

Kaynakça

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