Lancetからもコロナの血栓症についての議論

血栓止血学会のSNSでLancetが紹介されていました

Coagulation abnormalities and thrombosis in patients with COVID-19

*Marcel Levi, Jecko Thachil, Toshiaki Iba, Jerrold H Levy
marcel.levi@nhs.net
Cardiometabolic Programme, National Institute for Health Research University College London Hospitals (UCLH) Biomedical Research Centre, London, UK (ML); Department of Medicine, UCLH National Health Service Foundation Trust, London, NW1 2PG, UK (ML); Department of Haematology, Manchester Royal Infirmary, Manchester, UK (JT); Department of Emergency and Disaster Medicine, Jutendo University Graduate School of Medicine, Tokyo, Japan (TI); and Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA (JHL)

Panel: Management of coagulopathy in patients with severe COVID-19
Diagnostic approach
• Repeated (every 2–3 days) assessment of:

• D-dimer
• Prothrombin time
• Platelet counts
  Therapeutic management

• Subcutaneous low molecular weight heparin for all patients hospitalised
• Consider venous thromboembolism in patients with rapid respiratory deterioration and high D-dimer concentrations
  
  • Do CT angiography or ultrasound of the venous
    system of the lower extremities
  • If diagnostic testing is not possible and there are no
    bleeding risk factors, consider therapeutic
    anticoagulation
• Other interventions (such as plasma exchange, or
  administration of other anticoagulants or anti- inflammatory drugs) are experimental and should be considered in a clinical trial setting only

2

www.thelancet.com/haematology Published online May 11, 2020 https://doi.org/10.1016/S2352-3026(20)30145-9

どこにもPCR、抗原抗体検査については書かれていません。CTとって凝固指標をみて、抗血栓両方をやれ。と書いてます。もちろん、あくまで対処療法と重症化指標から見るその予防という観点ですから抗ウイルス薬、IL-6阻害薬、抗サイトカイン治療については触れられていません。血漿交換については下の通り。まあ、TTPでも行います。

Other anticoagulant modalities have not yet been systematically studied in patients with COVID-19 and cannot be advocated at this point. Plasma exchange could be helpful as a treatment of thrombotic microangiopathy by delivering high volumes of plasma, replenishing missing factors (eg, ADAMTS-13 or complement proteins) and removing excess inflam- matory mediators; however, this treatment needs to be further evaluated in a controlled trial setting.

https://www.thelancet.com/action/showPdf?pii=S2352-3026%2820%2930145-9&fbclid=IwAR2zY8g4eDVQmd_uAnBgPSJFe3_gQxXp8Eu9Y8ErOoVtTA-3936nX4jdbgE