Abstract
Coronavirus Disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is frequently complicated by thrombosis. In some cases of severe COVID-19, fibrinolysis may be markedly enhanced within a few days, resulting in fatal bleeding. In the treatment of COVID-19, attention should be paid to both coagulation activation and fibrinolytic activation. Various thromboses are known to occur after vaccination with SARS-CoV-2 vaccines. Vaccine-induced immune thrombotic thrombocytopenia (VITT) can occur after adenovirus-vectored vaccination, and is characterized by the detection of anti-platelet factor 4 antibodies by enzyme-linked immunosorbent assay and thrombosis in unusual locations such as cerebral venous sinuses and visceral veins. Treatment comprises high-dose immunoglobulin, argatroban, and fondaparinux. Some VITT cases show marked decreases in fibrinogen and platelets and marked increases in D-dimer, suggesting the presence of enhanced-fibrinolytic-type disseminated intravascular coagulation with a high risk of bleeding. In the treatment of VITT, evaluation of both coagulation activation and fibrinolytic activation is important, adjusting treatments accordingly to improve outcomes.
Keywords: COVID-19; SARS-CoV-2 vaccine; coagulopathy; enhanced-fibrinolytic-type DIC; fibrinolysis; nafamostat.
【저자키워드】 COVID-19, fibrinolysis, SARS-CoV-2 vaccine, Coagulopathy, enhanced-fibrinolytic-type DIC, nafamostat., 【초록키워드】 Treatment, coronavirus disease, SARS-CoV-2, Coronavirus disease 2019, coronavirus, vaccination, thrombosis, severe COVID-19, antibody, D-dimer, Platelets, SARS-CoV-2 vaccines, severe acute respiratory syndrome Coronavirus, fibrinolysis, immune, Coagulation, Coagulopathy, outcomes, enzyme-linked immunosorbent assay, Immunoglobulin, bleeding, Platelet, nafamostat, fibrinogen, respiratory, Disseminated intravascular coagulation, high risk, in some, argatroban, High-dose, acute respiratory syndrome, Activation, Thrombotic thrombocytopenia, fondaparinux, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, enzyme, fibrinolytic, thrombotic, decreases, intravascular coagulation, decrease, enzyme-linked immunosorbent, cerebral venous sinuses, IMPROVE, resulting, caused, characterized, occur, increases in, cerebral venous sinuse, visceral, 【제목키워드】 SARS-CoV-2,