Caracterização da Coagulopatia Associada ao COVID-19 usando Tromboelastometria Rotacional num Estudo Observacional de Coorte Prospetivo: Estudo HemoCov
DOI:
https://doi.org/10.20344/amp.19475Palavras-chave:
COVID-19, Fibrinólise, Perturbações da Coagulação Sanguínea, Tromboelastometria, TromboseResumo
Introdução: A coagulopatia associada à COVID-19 inclui inflamação sistémica e endotelial com desregulação da coagulação relacionada com imunotrombose. O objetivo deste estudo foi caracterizar esta complicação da infecção por SARS-CoV-2 em doentes com infeção COVID-19 moderada a grave.
Métodos: Estudo prospetivo observacional open-label conduzido em doentes com insuficiência respiratória aguda COVID-19 moderada a grave admitidos numa unidade de cuidados intensivos (UCI). Testes da coagulação, incluindo tromboelastometria, testes de bioquímica e variáveis clínicas foram colhidos em pontos de análise predefinidos durante 30 dias de internamento na UCI.
Resultados: Foram incluídos 145 doentes, 73,8% homens, com uma mediana de idade de 68 anos (intervalo interquartílico – IIQ 55 - 74). As comorbilidades mais prevalentes foram hipertensão arterial (63,4%), obesidade (44,1%) e diabetes (22,1%). Na admissão, o simplified acute physiology score II (SAPS II) apresentou uma mediana de 43,5 (11 - 105) e o sequential organ failure assessment (SOFA) de 7,5 (0 - 14). Durante a estadia na UCI, 66,9% dos doentes foram submetidos a ventilação mecânica invasiva e 18,4% a suporte com extracorporeal membrane oxygenation; Eventos trombóticos e hemorrágicos ocorreram em 22,1% e 15,1% dos doentes respetivamente; anticoagulação com heparina esteve presente em 99,2% dos doentes desde precocemente durante a estadia na UCI. A morte ocorreu em 35% dos doentes. Estudos longitudinais revelaram alterações em quase todos os testes da coagulação durante a hospitalização na UCI. O SOFA score, a contagem de linfócitos, alguns parâmetros bioquímicos, inflamatórios e da coagulação, incluindo hipercoagulabilidade e hipofibrinólise observados na tromboelastometria, diferiram significativamente (p < 0,05), entre a admissão e a alta da UCI. A hipercoagulabilidade e a hipofibrinólise persistiram ao longo da hospitalização na ICU, mostrando maior incidência e gravidade nos doentes não sobreviventes.
Conclusão: A coagulopatia associada à COVID-19 é caracterizada por hipercoagulabilidade e hipofibrinólise desde a admissão na UCI, as quais persistiram durante o curso clínico na infeção COVID-19 grave. Estas alterações foram mais pronunciadas nos doentes com maior gravidade e nos não sobreviventes.
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