PowerPoint PresentationProfessor of Medicine, F. Edward Hebert
School of Medicine
:
, . ,
COVID-19
1
Disclosures
• I have no financial or intellectual conflicts to disclose
2
Outline
• Underlying Pathophysiology
• Unique phenotype?
• Bottom Line
, COVID-19
,
COVID-19 VTE
3
In partnership with the CHEST Delegation Italy
congress.chestnet.org
, COVID-19
PE ,
ICU
, ,
,
, ICU
, , VTE
, -COVID
? VTE ?
4
,
-COVID ,
, , COVID-19
,
,
, ,
-
,
-
VIII
, ,
COVID-19 ARDS , -
,
- ,
, ,
5
VTE , , VTE 0.8
1.2% 1.6% PE VTE 1.5% 2.5%
6
-COVID ICU
, DVT 20% 67% ,
, 3% 35% , PE 6% 25%
,
7
8
COVID ,
,
COVID - DIC
, , ,
9
Pons et al. Critical Care (2020) 24:353
https://doi.org/10.1186/s13054-020-03062-7
, SARS-CoV-2
- , ACE2,
COVID-19 , -
, , -2 -6 IL-6 IL-2 ,
, IL-6 IL-6
-
, VIII ,
SARS-CoV-2 ,
-1 ,
IL-6 , , -
- TPA
10
, COVID-19
,
, ,
,
- ,
, , DVT ,
,
-
, - -
COVID-19 DVT PE PE DVT , PE 66 ICU , -
, VTE 5% -
11
,
, ,
,
() - VTE , ,
,
,
11
van Dam LF et al. Thromb Res 2020; 193:86-89
COVID-19
COVID-19 23
, COVID-19 PE 100
COVID-19
COVID COVID-19
, - , COVID-19 , PE , 17% -COVID 47% , RV LV 1 COVID-19
, -COVID 23%
12
van Dam LF et al. Thromb Res 2020; 193:86-89
, COVID-19
,
- ,
13
Fraissé et al. Critical Care (2020) 24:275
https://doi.org/10.1186/s13054-020-03025-y
, , COVID-19
, COVID-19 92 ICU , , VTE 34%
, 21% , ,
84% , 84%
, 50% , 11%
, , COVID-19
-COVID -
, COVID-19
COVID-19 ,
, VTE 1.8
COVID-19 ,
14
163 , 30
0.6% 0.7%
,
2.5% ,
- 2.9% ,
14
• LKMWH or fondaparinux over UFH and DOACs
• Insufficient data to justify routine increased intensity
Main Statements
, ,
,
,
,
, COVID-19
,
,
,
- ,
, DOAC
, ,
,
, ,
DOAC :
,
15
DOAC ,
COVID-19
Study name or PI Intervention Study name or PI Intervention
COVID-HEP Therapeutic LMWH or UFH COVI-DOSE Therapeutic LMWH
CORIMMUNO-COAG Therapeutic LMWH or UFH Albaghdadi Therapeutic LMWH
or UFH
ACOVACT Rivaroxaban 5 mg BID Heparin-SARS-CoV2 Intermediate-dose
LMWH
Perepu Intermediate-dose LMWH HeSAcovid Therapeutic LMWH or
UFH
REMAP-COVID Therapeutic LMWH or UFH COALIZAO ACTION Therapeutic
AC
Berger Therapeutic LMWH or UFH HEP-COVID Therapeutic LMWH
RAPID COVID COAG Therapeutic LMWH or UFH IMPACT Therapeutic
AC
X-Covid 19 Intermediate-dose LMWH COVID-19 HD Therapeutic
LMWH
ATTACC Therapeutic LMWH or UFH COVID PACT Therapeutic LMWH or UFH
±clopidogrel
IMPROVE-COVID Intermediate-dose LMWH or UFH COVID-PREVENT
Therapeutic rivaroxaban
, ,
, - -COVID - ,
,
,
16
•
[email protected]
, ,
17