RESUMEN
The extensive use of therapeutic doses of heparin to prevent thrombosis in critically ill patients with COVID-19 during the pandemic has led to an increased incidence of bleeding and heparin-induced thrombocytopenia (HIT). In addition, the introduction of the AstraZeneca and Johnson&Johnson vaccines against COVID-19 into clinical practice was associated with the development of a rare but very severe, adverse thrombotic complication, vaccine-induced immune thrombotic thrombocytopenia (VITT). Thrombotic complications of VITT turned out to be similar to HIT both clinically and pathophysiologically. HIT is a potentially fatal immune-mediated adverse drug response that results in emergence of antibodies that activate platelets in the presence of heparin. HIT is characterized by a high incidence of venous and arterial thromboses, often with fatal outcomes. Currently, there are clearly defined international guidelines for the diagnosis, treatment and prevention of HIT. In case of thrombotic complications, non-heparin anticoagulants should be used.
Asunto(s)
Anticoagulantes , COVID-19 , Heparina , Trombocitopenia , Humanos , Heparina/efectos adversos , Trombocitopenia/inducido químicamente , Anticoagulantes/efectos adversos , COVID-19/complicaciones , SARS-CoV-2 , Vacunas contra la COVID-19/efectos adversos , Trombosis/prevención & control , Trombosis/etiologíaRESUMEN
The novel coronavirus infection, COVID-19, is a highly contagious viral disease associated with acute, severe respiratory syndrome, which is based on the development of pronounced thrombo-inflammatory syndrome. As the number of patients with COVID-19 increased, heart damage has been reported, especially in patients with severe and critical COVID-19. This review describes the role of angiotensin-converting enzyme 2 receptor in the regulation of viral entry, the variety of damages to the heart and coronary arteries, and the importance of arterial hypertension and of the use of renin-angiotensin-aldosterone system inhibitors in the prognosis of patients with COVID-19.
Asunto(s)
COVID-19 , Hipertensión , Antagonistas de Receptores de Angiotensina , Inhibidores de la Enzima Convertidora de Angiotensina , Humanos , Sistema Renina-Angiotensina , SARS-CoV-2RESUMEN
This article discusses relevant aspects in the treatment of patients with COVID-19. Up-to-date information about principles for administration of statins, antithrombotics, and antiarrhythmics is presented. The authors addressed in detail specific features of reversing heart rhythm disorders in patients with coronavirus infection and the interaction of antiarrhythmic and antiviral drugs. Recommendations are provided for outpatient and inpatient antithrombotic therapy for patients with COVID-19. Issues of antithrombotic and antiviral drug interaction are discussed.
