Anticoagulant use in patients with SARS COV-2. When to prescribe?
Palavras Chaves: Coronavirus Infections, 2019-nCoV, SARS-CoV-2,Thrombosis, Macrophage Activation Syndrome, Heparin Low-Molecular-Weight, Disseminated Intravascular Coagulation.
Introduction: In December 2019, a series of pneumonia cases from unknown causes emerged in the city of Wuhan, China. The clinical presentations were similar to viral pneumonia and after sequencing analysis of samples from the patients' lower respiratory tract, a new coronavirus was identified, which was given the name 2019-nCoV (2019 novel coronavirus), a beta coronavirus belonging to the family coronaviridae.Its name was later changed to SARS-CoV-2 due to its genetic similarity to the previously known SARS-CoV, the virus that caused the 2002 pandemic in China. In the first months of the pandemic, it was observed that patients infected with Sars-Cov-2 that worsened rapidly, presented clinical and laboratory data compatible with Macrophage Activation Syndrome (MAS). This syndrome is the result of an exaggerated immune response, in which the proliferation of T cells and excessive activation of macrophages results in hypersecretion of pro inflammatory cytokines (IL 1 beta, IL 6, interferon and alpha TNF) and an increase in blood coagulability. The study aimed to review the pathogenesis domain, COVID-19 epidemiology, its relationship with the development of venous or arterial thrombosis and the need to use anticoagulants as prophylactic therapy. Methods: A descriptive and exploratory study with a qualitative and documentary approach was carried out, using evidence published on platforms such as: PubMed, Scielo, ScienceDirect, ScienceMag in addition to academic books, emphasizing the most relevant and still under discussed points . The questions asked included considerations for prescribing anticoagulants such as prophylactic therapy in Sars-Cov-2 infected patients, using the words: COVID-19, thrombosis, anticoagulant as descriptors. Results: A strong link between abnormal coagulation parameters and mortality has been proven. 71.4% of deaths and 0.6% of survivors presented evidence of disseminated intravascular coagulation. One of the studies followed 27 patients, it revealed that only 5 did not have D-dimer above 500 ng/mL. These took an average of 13 days until the start of anticoagulant therapy, where they received heparin in personalized doses, with better prognosis. Therefore, it is possible to justify the management of low molecular weight Heparin in a prophylactic dose (enlarged or not) in all patients tested positive, who do not present contraindications for its use. Conclusion: With the review we surmised that therapeutic strategies with the use of anticoagulants are essential to optimize the condition of infected patients. More prospective controlled studies addressing COVID-19 and increased blood coagulability are needed. In view of the international variability in preventive measures, diagnostic strategies and forms of treatment, the importance of the data obtained from the reviews carried out is perceived, as they help to clarify the presentation of the disease and its relationship with thromboembolism.
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