Buscar en
Medicina Clínica
Toda la web
Inicio Medicina Clínica COVID-19 and thrombosis: Beyond a casual association
Información de la revista
Vol. 155. Núm. 1.
Páginas 44 (Julio 2020)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 155. Núm. 1.
Páginas 44 (Julio 2020)
Letter to the Editor
DOI: 10.1016/j.medcli.2020.04.014
Acceso a texto completo
COVID-19 and thrombosis: Beyond a casual association
COVID-19 y trombosis: más que una asociación
Visitas
...
José López Castro
Internal Medicine Dep., Monforte Public Hospital, Lugo, Spain
Información del artículo
Texto completo
Bibliografía
Descargar PDF
Estadísticas
Texto completo
Dear Editor:

Despite various therapeutic schemes used since the onset of the SARS-CoV2 pandemic of COVID-19, mortality remains around 3–5% in the different countries that have reported cases.1 After the knowledge that the virus enters the cell through the union of its protein S with the receptor for ACE2 (angiotensin converting enzyme type 2)2 has been speculated with the suspension of certain pharmacological groups that due to their mechanism of action increase the presence of these receptors and therefore could increase the passage of virus into the alveolar cells, this point remaining in controversy. On the other hand, in a recently published retrospective series of cases, a frequent elevation of d-dimer has been observed, which has been related to acute pulmonary thrombosis, which has dramatically worsened the prognosis in this subgroup of patients.3 It is striking that those patients with a higher d-dimer also show more marked desaturations even without observing pneumonia on CTPA (Computarized Tomography Pulmonary Angiography).

Unlike hemorrhagic viruses (Ebola, Marburg...), SARS-Cov-2 could be a highly prothrombotic virus that causes alterations in the coagulation cascade not well characterized at present that would lead to a progressive elevation of d-dimer in function of the severity and extent of microthrombosis. In turn, this hypothesis could explain that these patients have a clearly worse prognosis since in them, orotracheal intubation would provide oxygen to a lung with no microvascular perfusion due to disseminated microthrombotic disease, which would also only be seen in CTPA in very advanced stages and in which little can be done to reverse this situation.4

Gradually a therapeutic scheme is being established that would include hydroxychloroquine and azithromycin5 (or in other cases lopinavir/ritonavir) in the early stages of moderate disease that does not require treatment in ICU (Intensive Care Unit) but given the analytical indication (elevation of d-dimer) and imaging (thrombosis in CTPA) in many cases, should be evaluated the early inclusion of low molecular weight heparin (LMWH) at doses of at least high-risk prophylaxis in all these patients without thrombopenia <20,000 platelets or acute bleeding and manifesting high d-dimer. Given the paucity of prospective studies, the need for urgent effective management, and the relative safety of these LMWH doses, the HAH (hydroxychloroquine–azithromycin–heparin) regimen could be tested in randomized clinical trials to improve the evolution of the disease in cases of torpid evolution.

References
[1]
C.Y. Huang, X.L. Wang.
Clinical features of patients infected with 2019 novel coronavirus in Wuhan China.
[2]
M. Hoffmann, H.K. Weber, N. Krüger, M. Müller, C. Drosten, S. Pöhlmann.
The novel coronavirus 2019 (2019-nCoV) uses the SARS-coronavirus receptor ACE2 and the cellular protease TMPRSS2 for entry into target cells.
[3]
Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.
[4]
J.W. Chen, Xiang, Zhang, Shutong, Liu, Bin, et al.
Findings of acute pulmonary embolism in COVID-19 patients, (2020),
[5]
P. Gautret, J.C. Lagier, P. Parola, V.T. Hoang, L. Meddeb, M. Mailhe, et al.
Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial.
Int J Antimicrob Agents, 20 (2020), pp. 105949
Copyright © 2020. Elsevier España, S.L.U.. All rights reserved
Opciones de artículo
Herramientas
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

es en pt
Política de cookies Cookies policy Política de cookies
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.