Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy
Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy
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DOI：
10.1016/j.thromres.2020.04.024
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发表时间：
2020-07-01
影响因子：
7.5
通讯作者：
Barco, Stefano
中科院分区：
文献类型：
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作者：
Lodigiani, Corrado;Iapichino, Giacomo;Barco, Stefano
背景资料：关于COVID-19住院患者血栓栓塞并发症的发生率和特征的数据很少。方法：我们研究了意大利米兰一所大学医院收治的连续症状性实验室确诊COVID-19患者（13.02.2020-10.04.2020）。主要结局是任何血栓栓塞并发症，包括静脉血栓栓塞（VTE）、缺血性卒中和急性冠状动脉综合征（ACS）/心肌梗死（MI）。结果：我们纳入了388例患者（中位年龄66岁，68%为男性，16%需要重症监护[ICU]）。100%的ICU患者和75%的普通病房患者使用了血栓预防。28例患者发生血栓栓塞事件（占已关闭病例的7.7%; 95%CI 5.4%-11.0%），相当于21%的累积发生率（ICU 27.6%，普通病房6.6%）。半数血栓栓塞事件在入院后24小时内确诊。44例患者接受了VTE影像学检查，16例（36%）确诊为VTE。CT肺动脉造影（CTPA）30例，占7.7%，肺栓塞10例（CTPA的33%）。缺血性卒中和ACS/MI的发生率分别为2.5%和1.1%。8例出现明显DIC（2.2%）例。大量的动脉，特别是，在入院24小时内诊断出静脉血栓栓塞事件，并且在少数接受检测的COVID-19患者中，VTE成像检测阳性率较高，这表明迫切需要改进特定的VTE诊断策略，并研究流动COVID患者血栓预防的有效性和安全性。19名患者。
Background: Few data are available on the rate and characteristics of thromboembolic complications in hospitalized patients with COVID-19.Methods: We studied consecutive symptomatic patients with laboratory-proven COVID-19 admitted to a university hospital in Milan, Italy (13.02.2020-10.04.2020). The primary outcome was any thromboembolic complication, including venous thromboembolism (VTE), ischemic stroke, and acute coronary syndrome (ACS)/myocardial infarction (MI). Secondary outcome was overt disseminated intravascular coagulation (DIC).Results: We included 388 patients (median age 66 years, 68% men, 16% requiring intensive care [ICU]). Thromboprophylaxis was used in 100% of ICU patients and 75% of those on the general ward. Thromboembolic events occurred in 28 (7.7% of closed cases; 95%CI 5.4%-11.0%), corresponding to a cumulative rate of 21% (27.6% ICU, 6.6% general ward). Half of the thromboembolic events were diagnosed within 24 h of hospital admission. Forty-four patients underwent VTE imaging tests and VTE was confirmed in 16 (36%). Computed tomography pulmonary angiography (CTPA) was performed in 30 patients, corresponding to 7.7% of total, and pulmonary embolism was confirmed in 10 (33% of CTPA). The rate of ischemic stroke and ACS/MI was 2.5% and 1.1%, respectively. Overt DIC was present in 8 (2.2%) patients.Conclusions: The high number of arterial and, in particular, venous thromboembolic events diagnosed within 24 h of admission and the high rate of positive VTE imaging tests among the few COVID-19 patients tested suggest that there is an urgent need to improve specific VTE diagnostic strategies and investigate the efficacy and safety of thromboprophylaxis in ambulatory COVID-19 patients.