Coagulopatia induzida pelo estado inflamatório da infecção pela Covid-19 / Coagulopathy induced by the inflammatory state of Covid infection 19

Authors

  • Rosa Gabryella Barreto Tiburi
  • Marina Catunda Pinheiro Jucá
  • Mikaele de Souza Sales
  • Ana Cristina Gomes de Sousa
  • Tallita Nikássia Leitão de Souza
  • Cláudio Gleidiston Lima da Silva
  • Maria do Socorro Vieira Gadelha

DOI:

https://doi.org/10.34119/bjhrv4n2-368

Keywords:

SARS-Cov-2, Coagulopatia, COVID-19.

Abstract

Os mecanismos de disfunção da coagulação na COVID-19 são complexos, contudo, algumas teorias fisiopatológicas já foram postuladas. Esta revisão sistemática objetiva identificar as evidências existentes na literatura sobre a correlação entre a coagulopatia e a infecção pelo SARS-Cov-2. Foram utilizados os descritores “SARS-Cov-2” e “coagulopathy” para uma pesquisa nas bases de dados “BVS” e “PubMed”, restrita aos trabalhos publicados entre 1 de janeiro de 2020 e 8 de janeiro de 2021, encontrando-se um total de 717 publicações; destes, apenas 36 trabalhos originais atenderam aos critérios de inclusão deste estudo. Observou-se que os principais fatores de risco associados a complicações ao longo da doença causada pelo SARS-Cov-2 foram idade avançada, sexo masculino, HAS, obesidade e diabetes mellitus. Apesar de ainda não esclarecida a patogênese exata da coagulopatia na COVID-19, algumas teorias foram propostas, tais como o desenvolvimento de um estado imunotrombótico associado a intenso estado inflamatório causado pela infecção, com maior formação de agregados de plaquetas-leucócitos circulantes. A endotelopatia e o aumento da reatividade plaquetária, com maior expressão de moléculas de adesão de células endoteliais e de marcadores de ativação plaquetária em pacientes graves, também teriam uma possível participação na patogênese da coagulopatia na COVID-19. Os estudos mostram, em sua maioria, uma baixa atividade dos anticoagulantes naturais e valores elevados de fibrinogênio, TP, TTPA, INR e D-dímero. A disfunção da coagulação pode manifestar-se por trombose venosa, arterial ou microvascular, havendo o aumento de eventos tromboembólicos como TVP, TEP, IAM e AVCi na vigência da infecção. O estudo de possíveis biomarcadores para fenômenos tromboembólicos na coagulopatia induzida pelo SARS-Cov-2 pode ser útil para orientação da terapia anticoagulante; esta terapia, por sua vez, mostrou-se favorável na redução do risco de complicações trombóticas, embora elas ainda possam ocorrer, sendo a heparina de baixo peso molecular a mais utilizada devido à sua atividade anti-inflamatória associada.

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Published

2021-04-15

Issue

Section

Original Papers