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Стационарозамещающие технологии: Амбулаторная хирургия

Расширенный поиск

COVID-19-ассоциированная коагулопатия: обзор современных рекомендаций по диагностике, лечению и профилактике

https://doi.org/10.21518/1995-1477-2020-3-4

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Аннотация

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.

Об авторах

К. В. Лобастов
Российский национальный исследовательский медицинский университет им. Н.И. Пирогова
Россия

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

117997, Москва, ул. Островитянова, д. 1



И. В. Счастливцев
Российский национальный исследовательский медицинский университет им. Н.И. Пирогова
Россия

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

117997, Москва, ул. Островитянова, д. 1



О. Я. Порембская
Северо-Западный государственный медицинский университет им. И.И. Мечникова
Россия

к.м.н., ассистент кафедры сердечно-сосудистой хирургии,

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



О. В. Дженина
Первый флебологический центр
Россия

к.м.н., врач-флеболог,

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



А. Б. Барганджия
Российский национальный исследовательский медицинский университет им. Н.И. Пирогова
Россия

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

117997, Москва, ул. Островитянова, д. 1



С. Н. Цаплин
Российский национальный исследовательский медицинский университет им. Н.И. Пирогова
Россия

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

117997, Москва, ул. Островитянова, д. 1



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Для цитирования:


Лобастов К.В., Счастливцев И.В., Порембская О.Я., Дженина О.В., Барганджия А.Б., Цаплин С.Н. COVID-19-ассоциированная коагулопатия: обзор современных рекомендаций по диагностике, лечению и профилактике. Стационарозамещающие технологии: Амбулаторная хирургия. 0;. https://doi.org/10.21518/1995-1477-2020-3-4

For citation:


Lobastov K.V., Schastlivtsev I.V., Porembskaya O.Y., Dzenina O.V., Bargandzhiya A.B., Tsaplin S.N. COVID-19-associated coagulopathy: review of current recommendations for diagnosis, treatment and prevention. Нospital-replacing technologies:Ambulatory surgery. 0;. (In Russ.) https://doi.org/10.21518/1995-1477-2020-3-4

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ISSN 1995-1477 (Print)
ISSN 2658-3542 (Online)