Routine Venous Thromboembolism Prophylaxis May Be Inadequate in the Hypercoagulable State of Severe Coronavirus Disease 2019
Routine Venous Thromboembolism Prophylaxis May Be Inadequate in the Hypercoagulable State of Severe Coronavirus Disease 2019
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DOI：
10.1097/ccm.0000000000004466
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发表时间：
2020-09-01
影响因子：
8.8
通讯作者：
Meagher, Ashley D.
中科院分区：
文献类型：
--
作者：
Maatman, Thomas K.;Jalali, Farid;Meagher, Ashley D.
目的：本研究的目的是确定危重 2019 年冠状病毒病患者中静脉血栓栓塞的频率，并将炎症标志物升高的程度与静脉血栓栓塞的发生相关联。设计：一项观察性研究，在 2020 年 3 月 12 日至 2020 年 3 月 31 日期间识别出患有严重 2019 年冠状病毒病的患者。报告的数据截至 2020 年 5 月 6 日。背景：一项多中心研究包括印第安纳波利斯地区的三所学术医院。 患者：三所医院之一收治了连续 240 名确诊严重急性呼吸综合征冠状病毒 2 感染的患者。分析包括 109 名入住 ICU 的 2019 年冠状病毒病重症患者。干预措施：所有患者均接受常规皮下化学静脉血栓栓塞预防。测量和主要结果：本研究的主要结果是确定静脉血栓栓塞的频率以及与静脉血栓栓塞发展相关的炎症和凝血标志物升高的程度。描述性统计数据概述了 2019 年严重冠状病毒病期间任何时间静脉血栓栓塞的频率。对发生静脉血栓栓塞的患者和未发生静脉血栓栓塞的患者的临床病程和实验室指标进行了比较。高凝血栓弹力图被定义为两个或多个高凝参数。 主要结果：109 名患者出现严重的 2019 年冠状病毒病，需要 ICU 护理。平均 (+/- 标准差) 年龄为 61 +/- 16 岁，其中 57% 为男性。 75 名患者（69%）出院回家，7 名患者（6%）仍在医院，27 名患者（25%）死亡。入院后 8 +/- 7 天，31 名患者 (28%) 被诊断出静脉血栓栓塞，其中包括两名入院时诊断为静脉血栓栓塞的患者。入院 D-二聚体和峰值 D-二聚体升高与静脉血栓栓塞的发生相关（p < 0.05）。 D-二聚体大于 2,600 ng/mL 可预测静脉血栓栓塞，受试者工作特征曲线下面积为 0.760（95% CI，0.661-0.858；p < 0.0001），敏感性为 89.7%，特异性为 59.5%。 12 名患者 (11%) 进行了血栓弹力图检查，其中 58% 的患者进行了高凝研究。通过血栓弹力图计算得出的凝血指数中有 50% 的患者处于高凝状态。结论：这些数据表明 2019 年冠状病毒病导致高凝状态。常规化学静脉血栓栓塞预防可能不足以预防 2019 年严重冠状病毒病的静脉血栓栓塞。
Objectives: The aim of this study was to determine the frequency of venous thromboembolism in critically ill coronavirus disease 2019 patients and associate a degree of inflammatory marker elevation to venous thromboembolism development.Design: An observational study that identified patients with severe coronavirus disease 2019 between March 12, 2020, and March 31, 2020. Data reported are those available through May 6, 2020.Setting: A multicenter study including three Indianapolis area academic hospitals.Patients: Two-hundred forty consecutive patients with confirmed severe acute respiratory syndrome coronavirus 2 infection were admitted to one of three hospitals. One-hundred nine critically ill coronavirus disease 2019 patients admitted to the ICU were included in the analysis.Interventions: All patients received routine subcutaneous chemical venous thromboembolism prophylaxis.Measurements and Main Results: The primary outcome of this study was to determine the frequency of venous thromboembolism and the degree of inflammatory and coagulation marker-elevation associated with venous thromboembolism development. Descriptive statistics outlined the frequency of venous-thromboembolism at any time during severe coronavirus disease 2019. Clinical course and laboratory metrics were compared between patients that developed venous thromboembolism and patients that did not develop venous thromboembolism. Hypercoagulable thromboelastography was defined as two or more hypercoagulable parameters.Main Results: One-hundred nine patients developed severe coronavirus disease 2019 requiring ICU care. The mean (+/- sd) age was 61 +/- 16 years and 57% were male. Seventy-five patients (69%) were discharged home, 7 patients (6%) remain in the hospital, and 27 patients (25%) died. Venous thromboembolism was diagnosed in 31 patients (28%) 8 +/- 7 days after hospital admission, including two patients diagnosed with venous thromboembolism at presentation to the hospital. Elevated admission D-dimer and peak D-dimer were associated with venous thromboembolism development (p < 0.05). D-dimer greater than 2,600 ng/mL predicted venous thromboembolism with an area under the receiver operating characteristic curve of 0.760 (95% CI, 0.661-0.858; p < 0.0001), sensitivity of 89.7%, and specificity of 59.5%. Twelve patients (11%) had thromboelastography performed and 58% of these patients had a hypercoagulable study. The calculated coagulation index was hypercoagulable in 50% of patients with thromboelastography.Conclusions: These data show that coronavirus disease 2019 results in a hypercoagulable state. Routine chemical venous thromboembolism prophylaxis may be inadequate in preventing venous thromboembolism in severe coronavirus disease 2019.