therapeuticЮжно-Российский журнал терапевтической практикиSouth Russian Journal of Therapeutic Practice2712-8156РостГМУ10.21886/2712-8156-2022-3-3-91-96therapeutic-255Research ArticleКЛИНИЧЕСКИЕ СЛУЧАИCLINICAL CASESКритическая коагулопатия у пациента с тяжелым течением COVID-19Markable coagulopathy in the patient with severe COVID-19https://orcid.org/0000-0002-6312-0427РощинаА. А.RoshchinaA. A.

Рощина Анна Алексеевна, кандидат медицинских наук, доцент кафедры госпитальной терапии лечебного факультета

 Саратов

SPIN-код: 2975-8592

Anna A. Roshchina, PhD, Associate Professor of the of Hospital Therapy Department of the Medical Faculty

Saratov

ranna9@yandex.ruЮпатоваМ. И.YupatovaM. I.

Юпатова Мария Игоревна, ординатор кафедры госпитальной терапии лечебного факультета

Саратов

Maria I. Yupatova, Resident of the Hospital Therapy Department of the Medical Faculty

Saratov

agent.smi@mail.ruhttps://orcid.org/0000-0002-0313-1191НикитинаН. М.NikitinaN. M.

Никитина Наталья Михайловна, доктор медицинских наук, профессор кафедры госпитальной терапии лечебного факультета

Саратов

Natalia M. Nikitina, Doctor of Medical Sciences, Professor of the of Hospital Therapy Department of the Medical Faculty

Saratov

nikina02@yandex.ruФГБОУ ВО «Саратовский ГМУ им. В. И. Разумовского» Минздрава РФРоссияFederal State Budgetary Educational Institution of Higher Education «Saratov State Medical University n. a. V. I. Razumovsky» of the Ministry of Health of the Russian FederationRussian Federation2022010920223397107Copyright © Рощина А.А., Юпатова М.И., Никитина Н.М., 20222022Рощина А.А., Юпатова М.И., Никитина Н.М.Roshchina A.A., Yupatova M.I., Nikitina N.M.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therapeutic-j.ru/jour/article/view/255

Важной особенностью патогенеза тяжелого течения новой коронавирусной инфекции (COVID-19) является разнообразие нарушений в свертывающей системе крови, что характеризуется усилением тромботических и микрососудистых осложнений. Аномальная коагулопатия напрямую взаимосвязана с риском летального исхода у больных COVID-19. Пациенты с COVID-19 имеют разнообразные изменения системы гемостаза, подобно синдрому диссеминированного внутрисосудистого свертывания (ДВС), тромботической микроангиопатии или антифосфолипидному синдрому, что является результатом сочетания воспаления с эндотелиальной дисфункцией, тромбоцитопенией потребления, тромбозом сосудов микроциркуляторного русла. Точный механизм коагулопатии, связанной с COVID, все еще выясняется, но, учитывая вероятную многофакторность этиопатогенеза, потенциирующие взаимодействия между иммунной системой и системой гемостаза в настоящее время возможно использование термина ковид - ассоциированная коагулопатия. Мы сообщаем о летальном случае 51-летнего мужчины с тяжелой тромбоцитопенией, значительным повышением фибринолитической активности системы гемостаза, развитием кожно-геморрагического синдрома и тромботических осложнений (инфаркт миокарда), вероятно связанных с развитием ДВС-синдрома на фоне тяжелого течения COVID-19, осложненного тяжелым острым респираторным синдромом (ТОРС). Этот случай подчеркивает необходимость дополнительных исследований механизмов развития коагулопатии при COVID-19 для предотвращения тяжелого течения заболевания и летальных исходов.

The variative coagulation abnormalities with thrombotic and microvascular complications are distinguishing feature of the severe new coronavirus infection (COVID-19) pathogenesis. Abnormal coagulopathy is directly related to the risk of death in COVID-19 patients. In many patients with COVID-19, hemostasis disorders have been observed, which increase the risk of developing DIC (disseminated intravascular coagulation), thrombotic microangiopathy or antiphospholipid syndrome as a result of the pathogenetic factors combination: inflammatory response, endothelial dysfunction, increased platelet consumption, microvascular thrombosis. The mechanism of coagulopathy associated with COVID is still being found, COVID-associated coagulopathy exemplifies the potentiating multi-factor interactions between the immune system and the coagulation. We’re reporting a fatal case of 51-year-old male with COVID-19, complicated by severe acute respiratory syndrome (SARS) and severe thrombocytopenia, markedly enhanced fibrinolytic activity with skin-hemorrhagic syndrome, thrombotic complication (myocardial infarction), probably related to the DIC. This case demonstrates the need more basic and clinical research is warranted to further our understanding of the role of coagulation disorders mechanism in COVID-19 to prevent severe outcomes and mortality.

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The authors declare that there are no conflicts of interest present.