Systematic assessment of venous thromboembolism in COVID-19 patients receiving thromboprophylaxis: incidence and role of D-dimer as predictive factors
Systematic assessment of venous thromboembolism in COVID-19 patients receiving thromboprophylaxis: incidence and role of D-dimer as predictive factors
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DOI：
10.1007/s11239-020-02146-z
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发表时间：
2020-05-25
影响因子：
4
通讯作者：
Lecomte, Raphael
中科院分区：
文献类型：
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作者：
Artifoni, Mathieu;Danic, Gwenvael;Lecomte, Raphael
COVID-19中的凝血病是一个紧迫的问题，预防血栓栓塞事件的策略存在争议且高度异质性。目的是确定接受血栓预防的COVID-19住院患者中静脉血栓栓塞（VTE）的发生率和风险因素。在这项回顾性法国队列研究中，纳入了在内科病房非ICU住院的确诊COVID-19和充分血栓预防的患者。如果临床怀疑深静脉血栓形成（DVT），则在出院时或更早时进行系统性下肢静脉多普勒超声检查。当怀疑肺栓塞（PE）时，进行胸部血管CT扫描。在71例患者中，尽管采取了充分的血栓预防措施，但仍有16例发生了VTE（22.5%），7例发生了PE（10%）。DVT患者的基线D-二聚体显著较高（p < 0.001）。有和无VTE患者的人口统计学、合并症、疾病表现、严重程度评分和其他生物学参数（包括炎症标志物）相似。基线D-二聚体水平< 1.0 μ g/ml对VTE和PE的阴性预测值分别为90%和98%。D-二聚体水平>= 1.0 μ g/ml和>= 3 μ g/ml时，VTE的阳性预测值分别为44%和67%。对于监测D-二聚体的患者，考虑到静脉多普勒超声检查前最新可用的D-二聚体水平，D-二聚体水平与VTE风险之间的相关性增加。尽管采取了血栓预防措施，但COVID-19非ICU住院患者发生VTE的风险很高。D-二聚体浓度增加超过1.0 μ g/ml可预测静脉血栓栓塞的风险。应在前瞻性研究中评价使用更高剂量肝素的D-二聚体水平指导的积极血栓预防方案。
Coagulopathy in COVID-19 is a burning issue and strategies to prevent thromboembolic events are debated and highly heterogeneous. The objective was to determine incidence and risk factors of venous thromboembolism (VTE) in COVID-19 inpatients receiving thromboprophylaxis. In this retrospective French cohort study, patients hospitalized in medical wards non-ICU with confirmed COVID-19 and adequate thromboprophylaxis were included. A systematic low limb venous duplex ultrasonography was performed at hospital discharge or earlier if deep venous thrombosis (DVT) was clinically suspected. Chest angio-CT scan was performed when pulmonary embolism (PE) was suspected. Of 71 patients, 16 developed VTE (22.5%) and 7 PE (10%) despite adequate thromboprophylaxis. D-dimers at baseline were significantly higher in patients with DVT (p < 0.001). Demographics, comorbidities, disease manifestations, severity score, and other biological parameters, including inflammatory markers, were similar in patients with and without VTE. The negative predictive value of a baseline D-dimer level < 1.0 mu g/ml was 90% for VTE and 98% for PE. The positive predictive value for VTE was 44% and 67% for D-dimer level >= 1.0 mu g/ml and >= 3 mu g/ml, respectively. The association between D-dimer level and VTE risk increased by taking into account the latest available D-dimer level prior to venous duplex ultrasonography for the patients with monitoring of D-dimer. Despite thromboprophylaxis, the risk of VTE is high in COVID-19 non-ICU inpatients. Increased D-dimer concentrations of more than 1.0 mu g/ml predict the risk of venous thromboembolism. D-dimer level-guided aggressive thromboprophylaxis regimens using higher doses of heparin should be evaluated in prospective studies.