Associação entre trombose venosa e COVID-19: revisão sistemática de ensaios clínicos sobre a eficácia da anticoagulação
DOI:
https://doi.org/10.34119/bjhrv8n5-043Keywords:
SARS-CoV-2, COVID-19, trombose venosaAbstract
Introdução: A infecção por SARS-CoV-2 tem se mostrado associada a múltiplas complicações tromboembólicas, especialmente em pacientes hospitalizados com quadros graves de COVID-19. A correlação entre a resposta inflamatória exacerbada e a ativação da cascata de coagulação tem sido foco de diversas pesquisas. Objetivo: Analisar a correlação entre a ocorrência de trombose venosa e a infecção por SARS-COV-2. Metodologia: Revisão sistemática de literatura utilizando a base de dados PubMed. Foram selecionados artigos publicados entre 2020 a 2025 nas línguas inglês, português e espanhol, com foco em complicações trombóticas associadas à COVID-19, em especial a TVP, priorizando ensaios clínicos. Resultados: A análise revelou aumento significativo da incidência de TVP em pacientes com COVID-19, especialmente em internações graves. A literatura destaca mecanismos inflamatórios, disfunção endotelial e ativação da cascata de coagulação. Conclusão: A análise dos ensaios clínicos revisados evidencia que a infecção por SARS-CoV-2 está associada a um risco aumentado de eventos tromboembólicos, principalmente em pacientes hospitalizados com quadros considerados moderados a graves.
References
AL-SAMKARI, Hanny et al. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood, v. 136, n. 4, p. 489-500, 2020. Disponível em: https://ashpublications.org/blood/article/136/4/489/460672/COVID-19-and-coagulation-bleeding-and-thrombotic. Acesso em: 20 maio 2025.
BLEDSOE, Joseph et al. Clinically stable covid-19 patients presenting to acute unscheduled episodic care venues have increased risk of hospitalization: secondary analysis of a randomized control trial. BMC Infectious Diseases, v. 23, n. 1, p. 325, 2023. Disponível em: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-023-08295-9. Acesso em: 17 abr. 2025.
BRASIL. Ministério da Saúde. Secretaria de Atenção Especializada à Saúde. Protocolo de Manejo Clínico para o Novo Coronavírus (2019-nCoV). Distrito Federal: Ministério da Saúde, 2020. 32 p. Disponível em: https://www.gov.br/saude/pt-br/assuntos/boletins-epidemiologicos-1/arquivos/2020/boletim_epidemiologico_covid_19_n2.pdf. Acesso em: 26 mar. 2025.
CASELLA, Ivan Benaduce. Physiopathology of SARS-CoV-2-infection-associated thrombosis. Jornal Vascular Brasileiro, v. 19, p. e20200128, 2020. Disponível em: https://www.scielo.br/j/jvb/a/XFB64SVVX9BjSTCGh35WMpd/?lang=en. Acesso em: 3 maio 2025.
CLARK, Carol L. et al. D-dimer in acute medically ill adults and current thromboprophylaxis: a multicenter observational study evaluating the prevalence of elevated D-dimer in acute medically ill, hospitalized adults and current thromboprophylaxis trends; the DAMIACT Study, initial data analysis. Res Pract Thromb Haemost, v. 1, n. S1, p. 567, 2017.
ELKHALIFA, Dana et al. A comprehensive review on the antiviral activities of chalcones. Journal of Drug Targeting, v. 29, n. 4, p. 403-419, 2021. Disponível em: https://www.tandfonline.com/doi/full/10.1080/1061186X.2020.1853759. Acesso em: 30 abr. 2025.
MAHER, Chris G. et al. Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical Therapy, v. 83, n. 8, p. 713–721, 2003. Disponível em: https://academic.oup.com/ptj/article/83/8/713/2805090. Acesso em: 13 jun. 2025.
IZCOVICH, Ariel et al. Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PloS One, v. 15, n. 11, p. e0241955, 2020. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241955. Acesso em: 22 abr. 2025.
JOHNS HOPKINS UNIVERSITY MEDICINE. Coronavirus Resource Center, 2023. Disponível em: https://coronavirus.jhu.edu/map.html. Acesso em: 5 maio 2025.
KAPOOR, Sumit et al. Thromboembolic events and role of point of care ultrasound in hospitalized Covid-19 patients needing intensive care unit admission. Journal of Intensive Care Medicine, v. 36, n. 12, p. 1483-1490, 2021. Disponível em: https://journals.sagepub.com/doi/abs/10.1177/0885066620964392. Acesso em: 18 abr. 2025.
NAGORNYKH, A. M. et al. SARS, SARS again, and MERS. Review of animal models of human respiratory syndromes caused by coronavirus infections. Journal of Microbiology, Epidemiology and Immunobiology, v. 97, n. 5, p. 431–444, 2020. Acesso em: 16 abr. 2025.
OPAS (Organização Pan-Americana de Saúde). Alerta epidemiológico - Complicações e sequelas da COVID-19. 2020. Disponível em: https://www.paho.org/bra/index.php?option=com_docman&view=document&slug=alerta-epidemiologico-complicacoes-e-sequelas-da-covid-19. Acesso em: 19 abr. 2025.
PAGE, Matthew J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, v. 372, 2021. Disponível em: https://www.bmj.com/content/372/bmj.n71. Acesso em: 4 mar. 2025.
PÁRAMO, José A. Coagulopatía y trombosis: similitudes y diferencias entre coronavirus patogénicos. In: Anales del Sistema Sanitario de Navarra. Gobierno de Navarra. Departamento de Salud, 2020. p. 245-249. Acesso em: 1 abr. 2025.
PEREIRA DE GODOY, Jose Maria et al. Increased prevalence of deep vein thrombosis and mortality in patients with Covid-19 at a referral center in Brazil. Phlebology, v. 37, n. 1, p. 21-25, 2022. Disponível em: https://journals.sagepub.com/doi/10.1177/02683555211041912. Acesso em: 24 mar. 2025.
PEREPU, Usha S. et al. Standard prophylactic versus intermediate dose enoxaparin in adults with severe COVID‐19: a multi‐center, open‐label, randomized controlled trial. Journal of Thrombosis and Haemostasis, v. 19, n. 9, p. 2225-2234, 2021. Disponível em: https://onlinelibrary.wiley.com/doi/10.1111/jth.15498. Acesso em: 6 abr. 2025.
PORTAL INFOSAÚDE-DF; SECRETARIA DE SAÚDE DO DISTRITO FEDERAL. Covid-19: Casos e óbitos no Brasil. 2024. Disponível em: https://infoms.saude.gov.br/extensions/covid-19_html/covid-19_html. Acesso em: 11 maio 2025.
RUECKEL, Johannes et al. COVID-19 Pandemic and Upcoming Influenza Season—Does an Expert’s Computed Tomography Assessment Differentially Identify COVID-19, Influenza and Pneumonias of Other Origin?. Journal of Clinical Medicine, v. 10, n. 1, p. 84, 2020. Disponível em: https://www.mdpi.com/2077-0383/10/1/84. Acesso em: 20 abr. 2025.
SALIBA JÚNIOR, Orlando Adas et al. Trombose venosa profunda de membros inferiores em pacientes com covid-19. Jornal Vascular Brasileiro, v. 22, p. e20230027, 2023. Disponível em: https://www.scielo.br/j/jvb/a/3ZK9FQ9Yk5Y9Y9Y9Y9Y9Y9Y9/?lang=pt. Acesso em: 15 maio 2025.
SANDHU, Adarsh et al. Global snapshot of the effects of the COVID-19 pandemic on the research activities of materials scientists between Spring and Autumn 2020. Science and Technology of Advanced Materials, v. 22, n. 1, p. 173-184, 2021. Disponível em: https://www.tandfonline.com/doi/full/10.1080/14686996.2020.1866640. Acesso em: 21 abr. 2025.
SAMANIEGO, Francisco; CONTE, Guillermo. SARS-CoV-2 infection as a thrombo-inflammatory endothelial disease. Revista Médica de Chile, v. 148, n. 10, p. 1467-1474, 2020. Disponível em: https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020001001467&lng=en&nrm=iso&tlng=en. Acesso em: 27 mar. 2025.
SHOLZBERG, Michelle et al. Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial. BMJ, v. 375, 2021. Disponível em: https://www.bmj.com/content/375/bmj.n2400. Acesso em: 7 mar. 2025.
SPYROPOULOS, Alex C. et al. Efficacy and safety of therapeutic-dose heparin vs standard prophylactic or intermediate-dose heparins for thromboprophylaxis in high-risk hospitalized patients with COVID-19: the HEP-COVID randomized clinical trial. JAMA Internal Medicine, v. 181, n. 12, p. 1612-1620, 2021. Disponível em: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2783089. Acesso em: 25 abr. 2025.
TANG, Ning; LI, Dengju; WANG, Xiong; SUN, Ziyong. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Journal of Thrombosis and Haemostasis, v. 18, n. 4, p. 844–847, 2020. Disponível em: https://onlinelibrary.wiley.com/doi/10.1111/jth.14768. Acesso em: 8 maio 2025.
VOCI, Davide et al. Enoxaparin for outpatients with COVID-19: 90-day results from the randomised, open-label, parallel-group, multinational, phase III OVID trial. Thrombosis research, v. 221, p. 157-163, 2023.
YUKI, Koichi; FUJIOGI, Miho; KOUTSOGIANNAKI, Sophia. COVID-19 pathophysiology: A review. Clinical Immunology, v. 215, p. 108427, 2020. Disponível em: https://www.sciencedirect.com/science/article/pii/S1521661620302214. Acesso em: 6 maio 2025.
