Актуальность

rehab

Реабилитология

Journal of Medical Rehabilitation

2949-58732949-5881

IRBIS LLC

10.17749/2949-5873/rehabil.2023.3

rehab-13

Research Article

ОБЗОРНЫЕ СТАТЬИ

REVIEW ARTICLES

Коррекция гемостаза в лечении и реабилитации пациентов с COVID-19

Hemostasis correction in the treatment and rehabilitation of COVID-19 patients

https://orcid.org/0000-0002-7756-8935

Григорьева

К. Н.

Grigoreva

К. N.

Григорьева Кристина Николаевна

Ул. Трубецкая, д. 8/2, Москва 119048

Kristina N. Grigoreva

8/2 Trubetskaya Str., Moscow 119048

grigkristik96@gmail.com

https://orcid.org/0000-0002-3509-9501

Гашимова

Н. Р.

Gashimova

N. R.

Гашимова Нилуфар Рамиль кызы. Scopus Author ID: 57808783500.

Ул. Трубецкая, д. 8/2, Москва 119048

Nilufar R. Gashimova. Scopus Author ID: 57808783500.

8/2 Trubetskaya Str., Moscow 119048

https://orcid.org/0000-0001-5888-0774

Цибизова

В. И.

Tsibizova

V. I.

Цибизова Валентина Ивановна - к.м.н.

Ул. Аккуратова, д. 2, Санкт-Петербург 197341

Valentina I. Tsibizova – PhD.

2 Akkuratov Str., Saint Petersburg 197341

Федеральное государственное автономное образовательное учреждение высшего образования «Первый Московский государственный медицинский университет им. И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияSechenov UniversityRussian Federation

Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр им. В.А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research CenterRussian Federation

2023

06092024

114959

2024

Григорьева К.Н., Гашимова Н.Р., Цибизова В.И.

Grigoreva К.N., Gashimova N.R., Tsibizova V.I.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.rehabilitology.com/jour/article/view/13

Актуальность

Актуальность. Известно, что тяжелое течение новой коронавирусной инфекции (НКИ) нередко сопровождается существенным риском возникновения нарушений со стороны системы гемостаза. В отличие от других видов коагулопатий, вирус-ассоциированная коагулопатия при COVID-19, по всей видимости, напрямую связана с провоспалительными процессами и неадекватным ответом со стороны иммунной системы.

Цель

Цель: определить основные механизмы развития иммуноопосредованной коагулопатии у пациентов с НКИ и способы коррекции данного патологического состояния.

Материал и методы

Материал и методы. Поиск исследований, посвященных изучению коагулопатии при COVID-19, лечению и реабилитации пациентов с данным осложнением проводили в международных научных базах данных PubMed/MEDLINE, Google Scholar, ScienceDirect и научной электронной библиотеке eLibrary. Глубина поиска составила 20 лет. Учитывали также результаты запросов в поисковых системах Яндекс и Google. После отбора публикаций, выполненного согласно рекомендациям PRISMA, в обзор включено 73 статьи.

Результаты

Результаты. «Порочный патологический круг», связанный с цитокиновым штормом, лежит в основе патогенетических механизмов иммуноопосредованного тромбоза у пациентов с COVID-19. Немалая роль в развитии коагулопатии отводится эндотелиальной дисфункции, внеклеточным ловушкам нейтрофилов (англ. neutrophil extracellular traps, NETs), тромбоцитопатии и изменению активности системы комплемента. Терапия осложнения носит в первую очередь патогенетический характер. Показана эффективность антикоагулянтов, противовоспалительных препаратов, антиагрегантов, а также препаратов, направленных на ограничение роли NETs и системы комплемента в развитии тромбозов. Рассматривается целесообразность профилактического применения антикоагулянтов у пациентов с COVID-19. Представлена информация о реабилитации больных с коагулопатией при НКИ. Продемонстрирована эффективность комбинированной противовоспалительной и антикоагулянтной терапии при COVID-19 как компонента комплексной реабилитации.

Заключение

Заключение. Процессы воспаления и иммунный ответ играют существенную роль в развитии коагулопатии у пациентов с НКИ. Совокупность всех патогенетических изменений со стороны иммунной системы, воспалительного ответа и системы гемостаза обусловливает сложность проведения терапевтических мероприятий. Общая схема реабилитации больных COVID-19 должна включать три этапа, также целесообразно своевременное применение комбинированной противовоспалительной и антикоагулянтной терапии.

Background

Background. It is well known that the severe course of a new coronavirus infection (NCI) is often accompanied by a significant risk of hemostasis system disorders. Virus-associated coagulopathy in COVID-19 differs from its other types. Apparently, it is directly related to inflammatory processes and an inadequate response from the immune system.

Objective

Objective: to determine the main mechanisms of immune-mediated coagulopathy development in NCI patients and methods of correcting this pathological condition.

Material and methods

Material and methods. The search for studies devoted to the specifics of coagulopathy course in COVID-19, treatment and rehabilitation of patients with this complication was carried out in international scientific research databases PubMed/ MEDLINE, Google Scholar, ScienceDirect and scientific electronic library (eLibrary). The search depth was 20 years. The results of queries in search engines Yandex and Google were also taken. After selection of publications performed according to PRISMA recommendations, 73 articles were included in the review.

Results

Results. A “vicious circle” associated with cytokine storm underlies the pathogenetic mechanisms of immune-mediated thrombosis in COVID-19 patients. A significant role of endothelial dysfunction, extracellular neutrophil traps (NETs), thrombocytopathy and changes in complement system activity is assigned to coagulopathy development. The therapy of this complication is aimed primarily at pathogenetic process. The effectiveness of anticoagulants, anti-inflammatory drugs, antiplatelet agents, drugs aimed at limiting the role of NETs and complement system in thrombosis development was shown. The expediency of preventive use of anticoagulants in COVID-19 patients was considered. Information was provided on the rehabilitation of NCI patients with coagulopathy. The effectiveness of combined anti-inflammatory and anticoagulant therapy in COVID-19 as a component of complex rehabilitation was indicated.

Conslusion

Conslusion. Inflammatory processes and immune response play an crucial role in coagulopathy development in NCI patients. The combination of all pathogenetic changes on the part of immune system, inflammatory response and hemostasis system makes it difficult to carry out therapeutic measures. The general scheme of rehabilitation for COVID-19 patients should include three stages, and timely use of combined anti-inflammatory and anticoagulant therapy is also advisable.

Новая коронавирусная инфекцияНКИCOVID-19гемостазкоагулопатияиммунитетлечениереабилитация

New coronavirus infectionNCICOVID-19hemostasiscoagulopathyimmunitytreatmentrehabilitation

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