Prevalence of thromboembolic events and status of prophylactic anticoagulant therapy in hospitalized patients with COVID-19 in Japan.
Prevalence of thromboembolic events and status of prophylactic anticoagulant therapy in hospitalized patients with COVID-19 in Japan.
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DOI：
10.1016/j.jiac.2021.02.019
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Imamura A
中科院分区：
文献类型：
--
作者：
Fujiwara S;Nakajima M;Kaszynski RH;Fukushima K;Tanaka M;Yajima K;Kobayashi T;Sekiya N;Yamamoto Y;Miwa M;Ishihata A;Yamauchi Y;Yamamoto K;Goto H;Imamura A
与 2019 年冠状病毒病 (COVID-19) 相关的最突出和最令人担忧的并发症之一是静脉和动脉血栓栓塞。本研究的目的是了解日本 COVID-19 患者血栓栓塞事件的患病率以及预防性抗凝治疗的现状。 2020年2月1日至8月31日期间，我们根据日本医疗机构收治的COVID-19患者的医疗图表中获得的数据进行了一项双中心回顾性队列研究。主要结局是任何血栓栓塞事件，包括肺栓塞（PE）、深静脉血栓（DVT）、心肌梗死、缺血性中风和其他全身性血栓栓塞。在研究期间，我们连续提取了 628 名因 COVID-19 入院的患者。 63 名患者 (10%) 接受了预防性抗凝治疗，其中 20 名患者 (31.7%) 入住重症监护病房 (ICU)。 18 名患者（2.9%）发生血栓栓塞事件（ICU 患者为 14.3%，普通病房患者为 2.2%）。 13 例 (2.1%) 患者检测到 DVT，11 例 (1.8%) 患者检测到 PE，6 例 (0.96%) 患者同时检测到 DVT 和 PE。随着临床严重程度的进展，血栓栓塞事件的发生率不断增加。总体院内死亡率为 4.8%。在所有住院的 COVID-19 患者中，只有 10% 接受了预防性抗凝治疗。 COVID-19 患者中任何血栓栓塞事件的发生率为 2.9%，其中大多数事件发生在重症和危重症患者中。因此，对于重症和危重症患者可能需要预防性抗凝治疗，但对于无症状至中度患者，这种做法仍然存在争议。
One of the most prominent and concerning complications associated with coronavirus disease 2019 (COVID-19) is venous and arterial thromboembolisms. The aim of the present study was to delineate the prevalence of thromboembolic events and the current status of prophylactic anticoagulation therapy in patients with COVID-19 in Japan. Between February 1 and August 31, 2020, we performed a dual-center, retrospective cohort study based on data obtained from the medical charts of COVID-19 patients admitted to healthcare facilities in Japan. The primary outcome was any thromboembolic event including pulmonary embolism (PE), deep vein thrombosis (DVT), myocardial infarction, ischemic stroke and other systemic thromboemboli. During the study period, we extracted 628 consecutive patients admitted for COVID-19. Prophylactic anticoagulant therapy was administered in 63 (10%) patients of whom 20 (31.7%) were admitted to the intensive care unit (ICU). Thromboembolic events occurred in 18 (2.9%) patients (14.3% of patients in ICU and 2.2% of patients in the general wards). DVT were detected in 13 (2.1%) patients, PE in 11 (1.8%), and both DVT and PE in 6 (0.96%) patients. An increasing prevalence in thromboembolic events was noted with progressive clinical severity. Overall in-hospital mortality was 4.8%. Prophylactic anticoagulation therapy was administered in only 10% of all hospitalized COVID-19 patients. The prevalence of any thromboembolic events was 2.9% in COVID-19 patients with most events occurring in severe and critical patients. Therefore, prophylactic anticoagulation therapy may be warranted in severe and critical patients but in asymptomatic to moderate patients the practice remains controversial.
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