pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2020-30-5-645-657pulmo-1369Research ArticleОБЗОРЫREVIEWКоагулопатия при COVID-19Coagulopathy in COVID-19https://orcid.org/0000-0001-8818-8949ГалстянГ. М.GalstyanG. M.

Галстян Геннадий Мартинович – д. м. н., заведующий отделением реанимации и интенсивной терапии

125167, Москва, Новый Зыковский проезд, 4тел.: (495) 612-48-59 

Gennady M. Galstyan – Doctor of Medicine, Head of the Division of Resuscitation and Intensive Care

Novozykovskiу pr. 4, Moscow, 125167tel.: (495) 612-48-59 

gengalst@gmail.comФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр гематологии» Министерства здравоохранения Российской ФедерацииРоссияNational Research Center for HematologyRussian Federation202026102020305645657Copyright © Галстян Г.М., 20202020Галстян Г.М.Galstyan G.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/1369

Нарушения гемостаза играют важную роль в патогенезе и клинических проявлениях COVID-19. Целью работы явилось подробное рассмотрение патогенеза, клинических проявлений, методов диагностики и лечения коронавирус-индуцированной коагулопатии (КИК). При дебюте COVID-19 выявляется гиперкоагуляция, а коагулопатия потребления, синдром диссеминированного внутрисосудистого свертывания (ДВС) регистрируются обычно на поздних стадиях заболевания. В патогенезе гиперкоагуляции при COVID-19 играют роль провоспалительные цитокины, гиперфибриногенемия, повышенное содержание в крови фактора Виллебранда, фактора VIII, нейтрофильных внеклеточных ловушек, активация тромбоцитов, выработка антифосфолипидных антител, микровезикулы. В лабораторных показателях выявляются повышенные плазменные концентрации D-димера, фибриногена, увеличение протромбинового времени и уменьшение количества тромбоцитов. Кумулятивная частота тромботических осложнений колеблется от 21 до 31 %. Факторами риска тромбозов являются пребывание в отделении интенсивной терапии, лейкоцитоз и высокая концентрация D-димера в плазме. Дифференциальный диагноз КИК следует проводить с ДВС-синдромом, сепсис-индуцированной коагулопатией, антифосфолипидным, гемофагоцитарным синдромами, тромботической микроангиопатией, гепарин-индуцированной тромоцитопенией. Возможно сочетание КИК с сепсисом, антифосфолипидным синдромом, гемофагоцитарным синдромом, тромботической микроангиопатией, гепарин-индуцированной тромбоцитопенией.

Основной терапией является лечение низкомолекулярными гепаринами. Приводятся рекомендации по лечению.

Hemostatic disorders play an important role in the pathogenesis and clinical manifestations of COVID-19. The purpose of the research was a detailed consideration of the pathogenesis, clinical manifestations, and methods of diagnosing and treatment of coronavirus-induced coagulopathy (CIC). At the onset of COVID-19, hypercoagulability is detected, and consumption coagulopathy and disseminated intravascular coagulation (DIC) syndrome are usually observed at later stages of the disease. In the pathogenesis of hypercoagulation in patients with COVID-19, proinflammatory cytokines, hyperfibrinogenemia, increased blood levels of von Willebrand factor, factor VIII, neutrophilic extracellular traps, platelet activation, production of antiphospholipid antibodies, microvesicles are of importance. Laboratory findings show increased plasma concentrations of D-dimer, fibrinogen, a longer prothrombin time and a decrease in the number of platelets. The cumulative incidence of thrombotic complications ranges from 21 to 31%. Thrombosis risk factors are intensive care unit stay, leukocytosis, and a high plasma D-dimer concentration. Differential diagnosing of CIC should be carried out with disseminated intravascular coagulation, sepsis-induced coagulopathy, antiphospholipid, hemophagocytic syndromes, thrombotic microangiopathy, and heparin-induced thromocytopenia. CIC may be complicated by sepsis, antiphospholipid syndrome, hemophagocytic syndrome, thrombotic microangiopathy, and heparin-induced thrombocytopenia.

The main therapy is low molecular weight heparins treatment. Treatment recommendations are provided.

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The authors declare that there are no conflicts of interest present.