Postdischarge thromboembolic outcomes and mortality of hospitalized patients with COVID-19: the CORE-19 registry.
Postdischarge thromboembolic outcomes and mortality of hospitalized patients with COVID-19: the CORE-19 registry.
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DOI：
10.1182/blood.2020010529
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发表时间：
2021-05-20
期刊：
影响因子：
20.3
通讯作者：
Spyropoulos AC
中科院分区：
文献类型：
--
作者：
Giannis D;Allen SL;Tsang J;Flint S;Pinhasov T;Williams S;Tan G;Thakur R;Leung C;Snyder M;Bhatia C;Garrett D;Cotte C;Isaacs S;Gugerty E;Davidson A;Marder GS;Schnitzer A;Goldberg B;McGinn T;Davidson KW;Barish MA;Qiu M;Zhang M;Goldin M;Matsagkas M;Arnaoutoglou E;Spyropoulos AC
在我们的登记中，出院后 90 天的 VTE、ATE 和 ACM 率分别为 1.55%、1.71% 和 4.83%。出院抗凝剂（主要是预防剂量）与主要血栓栓塞或 ACM 复合终点减少 46% 相关。血栓栓塞事件，包括静脉血栓栓塞 (VTE) 和动脉血栓栓塞 (ATE)，以及亚临床血栓事件导致的死亡在 2019 年冠状病毒病 (COVID-19) 住院患者中经常发生。出院后风险是否会延长一直存在争议。我们的前瞻性登记包括 2020 年 3 月 1 日至 5 月 31 日期间在我们的多医院系统内住院的连续 COVID-19 患者。我们记录了人口统计数据、合并症、实验室参数、药物、出院后血栓预防和 90 天结果。来自电子健康记录、健康信息交换、放射学数据库和电话随访的数据被合并。主要结局是判定的 VTE、ATE 和全因死亡率 (ACM) 的综合结果。主要安全性结局是大出血（MB）。 4906 名患者（53.7% 为男性）中，平均年龄为 61.7 岁。合并症包括高血压（38.6%）、糖尿病（25.1%）、肥胖（18.9%）和癌症史（13.1%）。 13.2% 的患者接受出院后血栓预防治疗。 VTE率为1.55%； ATE，1.71%； ACM，4.83%；和MB，1.73%。复合主要结局率为 7.13%，与高龄（比值比 [OR]，3.66；95% CI，2.84-4.71）、既往 VTE（OR，2.99；95% CI，2.00-4.47）、重症监护病房 (ICU) 住院时间（OR，2.22；95% CI，1.78-2.93）、慢性病显着相关肾脏疾病（CKD；OR，2.10； 95% CI，1.47-3.0）、外周动脉疾病（OR，2.04；95% CI，1.10-3.80）、颈动脉闭塞性疾病（OR，2.02；95% CI，1.30-3.14）、IMPROVE-DD VTE 评分≥4（OR，1.51；95% CI， 1.06-2.14）和冠状动脉疾病（OR，1.50；95% CI，1.04-2.17）。出院后抗凝治疗与主要结局的降低显着相关（OR，0.54；95% CI，0.47-0.81）。出院后 VTE、ATE 和 ACM 在 COVID-19 住院后频繁发生。高龄、心血管危险因素、CKD、IMPROVE-DD VTE 评分≥4 和入住 ICU 会增加风险。出院后抗凝治疗可将风险降低 46%。
In our registry, 90-day postdischarge VTE, ATE, and ACM rates were 1.55%, 1.71%, and 4.83%, respectively. Discharge anticoagulants, mostly prophylactic doses, were associated with 46% decrease in major thromboembolism or ACM composite end point. Thromboembolic events, including venous thromboembolism (VTE) and arterial thromboembolism (ATE), and mortality from subclinical thrombotic events occur frequently in coronavirus disease 2019 (COVID-19) inpatients. Whether the risk extends postdischarge has been controversial. Our prospective registry included consecutive patients with COVID-19 hospitalized within our multihospital system from 1 March to 31 May 2020. We captured demographics, comorbidities, laboratory parameters, medications, postdischarge thromboprophylaxis, and 90-day outcomes. Data from electronic health records, health informatics exchange, radiology database, and telephonic follow-up were merged. Primary outcome was a composite of adjudicated VTE, ATE, and all-cause mortality (ACM). Principal safety outcome was major bleeding (MB). Among 4906 patients (53.7% male), mean age was 61.7 years. Comorbidities included hypertension (38.6%), diabetes (25.1%), obesity (18.9%), and cancer history (13.1%). Postdischarge thromboprophylaxis was prescribed in 13.2%. VTE rate was 1.55%; ATE, 1.71%; ΑCM, 4.83%; and MB, 1.73%. Composite primary outcome rate was 7.13% and significantly associated with advanced age (odds ratio [OR], 3.66; 95% CI, 2.84-4.71), prior VTE (OR, 2.99; 95% CI, 2.00-4.47), intensive care unit (ICU) stay (OR, 2.22; 95% CI, 1.78-2.93), chronic kidney disease (CKD; OR, 2.10; 95% CI, 1.47-3.0), peripheral arterial disease (OR, 2.04; 95% CI, 1.10-3.80), carotid occlusive disease (OR, 2.02; 95% CI, 1.30-3.14), IMPROVE-DD VTE score ≥4 (OR, 1.51; 95% CI, 1.06-2.14), and coronary artery disease (OR, 1.50; 95% CI, 1.04-2.17). Postdischarge anticoagulation was significantly associated with reduction in primary outcome (OR, 0.54; 95% CI, 0.47-0.81). Postdischarge VTE, ATE, and ACM occurred frequently after COVID-19 hospitalization. Advanced age, cardiovascular risk factors, CKD, IMPROVE-DD VTE score ≥4, and ICU stay increased risk. Postdischarge anticoagulation reduced risk by 46%.
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