Тромботический шторм, нарушения гемостаза и тромбовоспаление в условиях COVID-19

Число сообщений о тромбозах и диссеминированном внутрисосудистом свертывании (ДВС) у пациентов с COVID-19 растет. Ключевые особенности состояния включают отсутствие риска кровотечения, умеренную тромбоцитопению, повышенный уровень фибриногена в плазме, а также компонентов комплемента в областях тромботической микроангиопатии (ТМА). Клиническая картина не типична для классического ДВС-синдрома. В данном обзоре систематизированы патогенетические механизмы формирования гиперкоагуляции при сепсисе, а также при его крайних формах у пациентов с COVID-19. К ним относятся иммунные механизмы тромбоза, активация комплемента, синдром активации макрофагов, формирование антифосфолипидных антител, гиперферритинемия, дисрегуляция ренин-ангиотензиновой системы и другие. Учитывая патогенетические механизмы, выделены и биомаркеры, отражающие прогноз развития заболевания. Пациенты с уже существующими сердечно-сосудистыми заболеваниями и другими факторами риска, включая ожирение, сахарный диабет, гипертоническую болезнь и пожилой возраст, подвергаются наибольшей опасности смерти от COVID-19. В этом обзоре мы обобщаем новые данные, указывающие на дисфункцию тромбоцитов и эндотелия, иммунотромбоз и как результат – тромботический шторм, как на важные компоненты патологии COVID-19.

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