asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/1995-1477-2020-3-4-36-51asurgery-203Research ArticleАНГИОЛОГИЯANGIOLOGYCOVID-19-ассоциированная коагулопатия: обзор современных рекомендаций по диагностике, лечению и профилактикеCOVID-19-associated coagulopathy: review of current recommendations for diagnosis, treatment and preventionhttps://orcid.org/0000-0002-5358-7218ЛобастовК. В.LobastovK. V.

Лобастов Кирилл Викторович, к.м.н., доцент кафедры общей хирургии и лучевой диагностики лечебного факультета

117997, Россия, Москва, ул. Островитянова, д. 1

Kirill V. Lobastov, Cand. of Sci. (Med.), Associate Professor of the Department of General Surgery and X-Ray Diagnostics of the Faculty of Medicine

1, Ostrovityanov St., Moscow, 117997, Russia

lobastov_kv@mail.ruhttps://orcid.org/0000-0002-1306-1502СчастливцевИ. В.SchastlivtsevI. V.

Счастливцев Илья Вениаминович, к.м.н., доцент, доцент кафедры общей хирургии и лучевой диагностики лечебного факультета

117997, Россия, Москва, ул. Островитянова, д. 1

Ilya V. Schastlivtsev, Cand. of Sci. (Med.), Associate Professor, Associate Professor of the Department of General Surgery and X-Ray Diagnostics of the Faculty of Medicine

1, Ostrovityanov St., Moscow, 117997, Russia

Schastlivtsev.ilya@gmail.comhttps://orcid.org/0000-0003-3537-7409ПорембскаяО. Я.PorembskayaO. Ya.

Порембская Ольга Ярославна, к.м.н., ассистент кафедры сердечно-сосудистой хирургии

191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41

Olga Ya. Porembskaya, Cand. of Sci. (Med.), Assistant Professor of the Department of Cardiovascular Surgery

41, Kirochnaya St., St Petersburg, 191015, Russia

porembskaya@yandex.ruhttps://orcid.org/0000-0003-3811-5156ДженинаО. В.DzeninaO. V.

Дженина Ольга Вадимовна, к.м.н., врач-флеболог

117447, Россия, Москва, ул. Дмитрия Ульянова, д. 31

Olga V. Dzenina, Cand. of Sci. (Med.), Phlebologist

31, Dmitry Ulyanov St., Moscow, 117447, Russia

helgelman@mail.ruhttps://orcid.org/0000-0003-3757-8861БарганджияА. Б.BargandzhiyaA. B.

Барганджия Астанда Беслановна, к.м.н., ассистент кафедры общей хирургии и лучевой диагностики лечебного факультета

117997, Россия, Москва, ул. Островитянова, д. 1

Astanda B. Bargandzhiya, Cand. of Sci. (Med.), Assistant Professor of the Department of General Surgery and X-Ray Diagnostics of the Faculty of Medicine

1, Ostrovityanov St., Moscow, 117997, Russia

astandasofiya@gmail.comhttps://orcid.org/0000-0003-1567-1328ЦаплинС. Н.TsaplinS. N.

Цаплин Сергей Николаевич, к.м.н., доцент кафедры общей хирургии и лучевой диагностики лечебного факультета

117997, Россия, Москва, ул. Островитянова, д. 1

Sergey N. Tsaplin, Cand. of Sci. (Med.), Associate Professor of the Department of General Surgery and X-Ray Diagnostics of the Faculty of Medicine

1, Ostrovityanov St., Moscow, 117997, Russia

tsaplin-sergey@rambler.ruРоссийский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationСеверо-Западный государственный медицинский университет им. И.И. МечниковаРоссияNorth-Western State Medical University named after I.I. MechnikovRussian FederationПервый флебологический центрРоссияFirst Phlebological CenterRussian Federation20201301202103-43651Copyright © Лобастов К.В., Счастливцев И.В., Порембская О.Я., Дженина О.В., Барганджия А.Б., Цаплин С.Н., 20212021Лобастов К.В., Счастливцев И.В., Порембская О.Я., Дженина О.В., Барганджия А.Б., Цаплин С.Н.Lobastov K.V., Schastlivtsev I.V., Porembskaya O.Y., Dzenina O.V., Bargandzhiya A.B., Tsaplin S.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/203

Коронавирусная инфекция COVID-19 является высококонтагиозным заболеванием, вызванным вирусом SARS-CoV-2. Специфические протромботические изменения системы гемостаза при COVID-19 ассоциируются с повышенной частотой возникновения венозных тромбоэмболических осложнений. Статья представляет собой обзор литературы по диагностике, лечению и профилактике коагулопатии и венозных тромбоэмболических осложнений, ассоциированных с COVID-19. Изучено 11 исследований, оценивающих частоту регистрации венозных тромбоэмболических осложнений, и 11 клинических рекомендаций по коррекции коагулопатии, опубликованных до 22 мая 2020 г. Частота развития венозных тромбоэмболических осложнений оказалась неожиданно высокой: 8–13% в отделении общего профиля и 9–18% в отделении интенсивной терапии на фоне превентивных мероприятий. Профилактические дозы антикоагулянтов, низкомолекулярные гепарины или нефракционированный гепарин показаны всем госпитализированным пациентам. Продленная профилактика после выписки из стационара может быть рекомендована лицам с высоким риском венозных тромбоэмболических осложнений и низким риском кровотечения. Увеличение Д-димера может рассматриваться в качестве показания для инструментального поиска венозных тромбоэмболических осложнений. При подозрении на развитие венозных тромбоэмболических осложнений антикоагулянтная терапия в лечебных дозах может быть начата до подтверждения диагноза: в период стационарного лечения следует отдавать предпочтение низкомолекулярным гепаринам или нефракционированным гепаринам, после выписки из стационара рекомендуется перевод на прямые оральные антикоагулянты на срок не менее 3 мес. Рутинная профилактика венозных тромбоэмболических осложнений у амбулаторных пациентов не рекомендуется.

The coronavirus infection COVID-19 is a highly contagious disease caused by the SARS-CoV-2 virus. Specific prothrombotic changes of the hemostasis system in COVID-19 are associated with increased incidence of venous thromboembolic complications. The article is a literature review on the diagnosis, treatment and prevention of coagulopathy and venous thromboembolic complications associated with COVID-19. 11 studies evaluating the frequency of registration of venous thromboembolic complications and 11 clinical recommendations on correction of coagulopathy published before May 22, 2020 have been studied. The frequency of venous thromboembolic complications was unexpectedly high: 8–13% in the general ward and 9–18% in the intensive care unit against the background of preventive measures. Preventive doses of anticoagulants, low-molecular weight heparins or unfractionated heparin are indicated to all hospitalized patients. Prolonged prophylaxis after discharge from hospital can be recommended for those at high risk of venous thromboembolic complications and low risk of bleeding. An increase in D-dimer may be considered as an indication for instrumental detection of venous thromboembolic complications. If there is a suspicion of venous thromboembolic complications, anticoagulant therapy at therapeutic doses can be started before the diagnosis is confirmed: during inpatient treatment preference should be given to low-molecular heparin or unfractionated heparin, after discharge from hospital it is recommended to transfer to direct oral anticoagulants for a period of at least 3 months. Routine prevention of venous thromboembolic complications in ambulatory patients is not recommended.

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