COVID-19 и тромботическая микроангиопатия

Как было показано многочисленными исследованиями, проведенными в период пандемии, тяжелое течение COVID-19 сопровождается полиорганной недостаточностью. Цитокиновый шторм, гиперкоагуляция, гиперактивация комплемента и другие звенья гемостаза составляют общую картину патогенеза тяжелого течения заболевания. Частая диагностика множественных тромбозов микрососудистого русла в таких органах как легкие, сердце и почки, а также присутствие тромбоцитарно-фибриновых тромбов в этих органах и признаки их терминального повреждения наводят на мысль о возможном участии тромботической микроангиопатии (ТМА) в развитии полиорганной недостаточности. В этой связи особенно важно своевременно диагностировать ТМА и начинать патогенетическую терапию. Эти мероприятия способны значительно снизить смертность от нового заболевания. Гепарины и прямые пероральные антикоагулянты являются основой профилактики и лечения венозной тромбоэмболии у пациентов с COVID-19, однако их эффективность при наличии ТМА сомнительна. Доказано, что использование антикоагулянтов у тяжелобольных пациентов с COVID-19 для профилактики тромбоза крупных сосудов эффективно, однако их роль в предотвращении микротромбообразования не ясна. В данной статье проводится обзор имеющейся в настоящее время информации о ТМА, а также обзор данных литературы, описывающих ТМА-подобные состояния при COVID-19, обсуждается возможная патофизиология развития состояния и предполагаемые подходы к терапии.

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