Coagulopatías: El nuevo reto del COVID-19

  • Sandra Nazira Vieda-Salomón Pontificia Universidad Javeriana Cali https://orcid.org/0000-0002-2937-1759
  • Juan Manuel Ortega-Escobar Pontificia Universidad Javeriana Cali
Palabras clave: SARS-CoV-2, COVID-19, Trombosis, Coagulación, Tromboembolismo, Coagulopatías, UCI, Homeostasis

Resumen

Esta revisión de tema tiene como objetivo analizar las implicaciones de los diferentes mecanismos por los cuales se presentan los trastornos en los parámetros de coagulación de los pacientes con COVID-19 grave y que se asocian a coagulopatías durante su estancia hospitalaria. Se consultó la base de datos MEDLINE como fuente principal para la discusión, además de consultas en libros y otras fuentes académicas para entender la fisiopatología de infección. Se escogieron artículos publicados entre enero de 2020 y mayo 23 de 2020, con las palabras clave SARS-CoV-2, COVID-19, coagulopathy, thrombosis. Se realizó la lectura y el análisis de 11 artículos con información actualizada y relevante sobre la presencia de coagulopatías en el paciente críticamente enfermo admitidos en UCI por neumonía causada por COVID-19 en la discusión. Al finalizar la revisión de la literatura se encontró que existe una pérdida de la homeostasis hematológica por la tormenta citoquímica de la respuesta inmunológica generalizada por la amplia distribución del receptor ACE2.

Abstract:

The objective of this paper, aims to review the implications of different theories, based on evidence that shows that disorders in the coagulation parameters of patients with severe COVID-19 are associated with coagulopathies. The database MEDLINE was consulted as a primary source for the discussion; in addition, consultations were carried out in books and other academic sources such as journals to understand the physiopathology. Publications between January 2020 and May 23, 2020 were chosen, using the keywords SARS-CoV-2, Covid19, coagulopathy and thrombosis. The readings and the analyses of 11 articles that had updated content and relevant information of the presence of coagulopathies in critically ill patients admitted to the ICU due to COVID-19 pneumonia were incorporated in the analysis research. At the end of the literature review, it was found that there is a loss of hematological homeostasis due to the cytokine storm of the immune response related to the wide distribution of the ACE2 receptor.

Key words: SARS-CoV-2, COVID-19, thrombosis, coagulation, thromboembolism, blood coagulation disorder, ICU, homeostasis.

Biografía del autor/a

Sandra Nazira Vieda-Salomón, Pontificia Universidad Javeriana Cali

Estudiante de medicina, Semillero de Innovadores en Salud ISSEM.

Juan Manuel Ortega-Escobar, Pontificia Universidad Javeriana Cali

Estudiante de medicina, Semillero de Innovadores en Salud ISSEM.

Citas

Johns Hopkins University. COVID-19 dashboard by the center for systems science and engineering (CSSE) at Johns Hopkins University (JHU). Disponible en: https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

Gandhi RT, Lynch JB, del Rio C. Mild or moderate covid-19. N Engl J Med. 2020. DOI: 10.1056/NEJMcp2009249. doi: 10.1056/NEJMcp2009249.

Song JC, Wang G, Zhang W, Zhang Y, Li WQ, Zhou Z. People’s Liberation Army Professional Committee of Critical Care Medicine, Chinese Society on Thrombosis and Haemostasis. Chinese expert consensus on diagnosis and treatment of coagulation dysfunction in COVID-19. Mil Med Res. 2020; 7(1):19. DOI: 10.1186/s40779-020-00247-7.

Debuc B, Smadja DM. Is COVID-19 a New Hematologic Disease? Stem Cell Rev Rep. 2020; 1-5. DOI: 10.1007/s12015-020-09987-4.

Lillicrap D. Disseminated intravascular coagulation in patients with 2019-nCoV pneumonia. J Thromb Haemost. 2020 ;18(4):786-787. DOI: 10.1111/jth.14781.

Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020. DOI: 10.1182/blood.2020006000.

Varga Z, Flammer AJ, Steiger P et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020; 395:1417-1418.

Levi M, Scully M. How I treat disseminated intravascular coagulation. Blood 2018; 131:845-854.

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; S0049-3848(20)30120-1. DOI: 10.1016/j.thromres.2020.04.013.

Poissy J, Goutay J, Caplan M, Parmentier E, Duburcq T, Lassalle F et al. Haemostasis COVID-19 group. Pulmonary Embolism in COVID-19 Patients: Awareness of an Increased Prevalence. Circulation. 2020. DOI: 10.1161/CIRCULATIONAHA.120.047430.

Helms J, Tacquard C, Severac F et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med (2020). DOI: 10.1007/s00134-020-06062-x

Spiezia L, Boscolo A, Poletto F, Cerruti L, Tiberio I, Campello E et al. COVID-19-Related Severe Hypercoagulability in Patients Admitted to Intensive Care Unit for Acute Respiratory Failure. Thromb Haemost. 2020. DOI: 10.1055/s-0040-1710018.

Pavoni V, Gianesello L, Pazzi M, Stera C, Meconi T, Frigieri FC. Evaluation of coagulation function by rotation thromboelastometry in critically ill patients with severe COVID-19 pneumonia. J Thromb Thrombolysis. 202; 1-6. DOI: 10.1007/s11239-020-02130-7.

Panigada M, Bottino N, Tagliabue P, Grasselli G, Novembrino C, Chantarangkul V et al. Hypercoagulability of COVID-19 patients in Intensive Care Unit. A Report of Thromboelastography Findings and other Parameters of Hemostasis. J Thromb Haemost. 2020. DOI: 10.1111/jth.14850.

Llitjos JF, Leclerc M, Chochois C, Monsallier JM, Ramakers M, Auvray M et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. J Thromb Haemost. 2020. DOI: 10.1111/jth.14869.

Yin S, Huang M, Li D, Tang N. Difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2. J Thromb Thrombolysis. 2020:1-4. DOI: 10.1007/s11239-020-02105-8. 32246317; PMCID: PMC7124128.

Griffin DO, Jensen A, Khan M et al. Pulmonary embolism and increased levels of d-dimer in patients with coronavirus disease. Emerging Infectious Disease Journal. 2020; 26(8). DOI: 10.3201/eid2608.201477.

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 Mar 28;395(10229):1054-1062. DOI: 10.1016/S0140-6736(20)30566-3.

Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and antiphospholipid antibodies in patients with covid-19. N Engl J Med. 2020; 382(17):e38. https://doi.org/10.1056/NEJMc2007575. doi: 10.1056/NEJMc2007575.

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(4):844-847. DOI: 10.1111/jth.14768.

Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020; 8(5):475-481. DOI: 10.1016/S2213-2600(20)30079-5.

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(10223):497-506. DOI: 10.1016/S0140-6736(20)30183-5.

Conti P, Ronconi G, Caraffa A, Gallenga CE, Ross R, Frydas I et al. Induction of pro-inflammatory cytokines (IL-1 and IL-6) and lung inflammation by Coronavirus-19 (COVI-19 or SARS-CoV-2): Anti-inflammatory strategies. J Biol Regul Homeost Agents. 2020; 34(2):1. DOI: 10.23812/CONTI-E.

Amgalan A, Othman M. Exploring possible mechanisms for COVID-19 induced thrombocytopenia: Unanswered questions. J Thromb Haemost. 2020. DOI: 10.1111/jth.14832.

Deng Y, Liu W, Liu K, Fang YY, Shang J, Zhou L et al. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 (COVID-19) in Wuhan, China: a retrospective study. Chin Med J (Engl). 2020. DOI: 10.1097/CM9.0000000000000824.

Campbell CM, Kahwash R. Will Complement Inhibition be the New Target in Treating COVID-19 Related Systemic Thrombosis? Circulation. 2020. DOI: 10.1161/CIRCULATIONAHA.120.047419.

Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Transl Res. 2020; S1931-5244(20)30070-0. DOI: 10.1016/j.trsl.2020.04.007.

Abbas A, Lichtman A. Inmunología celular y molecular. Séptima edición. Elsevier: Madrid; 2012.

Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-1. N Engl J Med. 2020. DOI: 10.1056/NEJMoa2015432

Antoniak S, Mackman N. Multiple roles of the coagulation protease cascade during virus infection. Blood. 2014; 123(17):2605-13. DOI: 10.1182/blood-2013-09-526277.

Delabranche X, Helms J, Meziani F. Immunohaemostasis: a new view on haemostasis during sepsis. Ann Intensive Care. 2017; 7(1):117. DOI: 10.1186/s13613-017-0339-5.

Barnes BJ, Adrover JM, Baxter-Stoltzfus A, Borczuk A, Cools-Lartigue J, Crawford JM et al. Targeting potential drivers of COVID-19: Neutrophil extracellular traps. J Exp Med. 2020 Jun 1; 217(6):e20200652. DOI: 10.1084/jem.20200652.

Glas GJ, Van Der Sluijs KF, Schultz MJ, Hofstra JJ, Van Der Poll T, Levi M. Bronchoalveolar hemostasis in lung injury and acute respiratory distress syndrome. J Thromb Haemost. 2013; 11(1):17-25. DOI: 10.1111/jth.12047.

Hanley B, Lucas SB, Youd E, Swift B, Osborn M. Autopsy in suspected COVID-19 cases. J Clin Pathol 2020;73:239-242. DOI:10.1136/jclinpath-2020-206522

Ji HL, Zhao R, Matalon S, Matthay MA. Elevated Plasminogen as a Common Risk Factor for COVID-19 Susceptibility. Physiol Rev. 2020; 100(3):1065-1075. DOI: 10.1152/physrev.00013.2020.

Iba T, Levy JH, Levi M, Connors JM, Thachil J. Coagulopathy of Coronavirus Disease 2019. Critical Care Medicine. 2020. DOI: 10.1097/CCM.0000000000004458

Publicado
2020-08-12
Cómo citar
Vieda-Salomón, S., & Ortega-Escobar, J. (2020). Coagulopatías: El nuevo reto del COVID-19. Salutem Scientia Spiritus, 6(1), 94-100. Recuperado a partir de https://revistas.javerianacali.edu.co/index.php/salutemscientiaspiritus/article/view/2347