Incidence of venous thromboembolism in hospitalized patients with COVID-19
Incidence of venous thromboembolism in hospitalized patients with COVID-19
复制标题
DOI：
10.1111/jth.14888
复制
发表时间：
2020-07-27
影响因子：
10.4
通讯作者：
van Es, Nick
中科院分区：
文献类型：
--
作者：
Middeldorp, Saskia;Coppens, Michiel;van Es, Nick
背景：冠状病毒病2019(新冠肺炎)可导致全身凝血激活和血栓性并发症。目的了解住院新冠肺炎患者客观确诊静脉血栓栓塞症的发生率。方法对198例新冠肺炎住院患者进行单中心队列研究。结果75例患者(38%)住进重症监护病房(ICU)。在数据收集时，16人(8%)仍在住院，19%已死亡。在平均7天的随访期间(IQR，3-13)，39名患者(20%)被诊断为VTE，其中25名(13%)有症状VTE，尽管进行了常规的血栓预防。VTE累积发生率分别为16%(95%可信区间，10~22天)、33%(95%可信区间，23~43天)和42%(95%可信区间30~54天)。症状性VTE分别为10%(95%CI，5.8~16)、21%(95%CI，14~30)和25%(95%CI 16~36)。静脉血栓形成似乎与死亡相关(调整后的HR，2.4；95%CI，1.02-5.5)。ICU内VTE的累积发生率(7、14、21天分别为26%(95%CI，17~37)、47%(95%CI，34~58)、59%(95%CI，42~72))均高于病房(7、14、21天时)(分别为5.8%(95%CI，1.4~15)、9.2%(95%CI，2.6~21)和9.2%(2.6~21))。结论新冠肺炎患者发生VTE的危险性较高，ICU患者发生VTE的风险较高，临床怀疑程度较高，DVT或PE的影像诊断阈值较低。未来的研究应侧重于最佳的诊断和预防策略，以预防VTE并潜在地提高存活率。
Background Coronavirus disease 2019 (COVID-19) can lead to systemic coagulation activation and thrombotic complications. Objectives To investigate the incidence of objectively confirmed venous thromboembolism (VTE) in hospitalized patients with COVID-19. Methods Single-center cohort study of 198 hospitalized patients with COVID-19. Results Seventy-five patients (38%) were admitted to the intensive care unit (ICU). At time of data collection, 16 (8%) were still hospitalized and 19% had died. During a median follow-up of 7 days (IQR, 3-13), 39 patients (20%) were diagnosed with VTE of whom 25 (13%) had symptomatic VTE, despite routine thrombosis prophylaxis. The cumulative incidences of VTE at 7, 14 and 21 days were 16% (95% CI, 10-22), 33% (95% CI, 23-43) and 42% (95% CI 30-54) respectively. For symptomatic VTE, these were 10% (95% CI, 5.8-16), 21% (95% CI, 14-30) and 25% (95% CI 16-36). VTE appeared to be associated with death (adjusted HR, 2.4; 95% CI, 1.02-5.5). The cumulative incidence of VTE was higher in the ICU (26% (95% CI, 17-37), 47% (95% CI, 34-58), and 59% (95% CI, 42-72) at 7, 14 and 21 days) than on the wards (any VTE and symptomatic VTE 5.8% (95% CI, 1.4-15), 9.2% (95% CI, 2.6-21), and 9.2% (2.6-21) at 7, 14, and 21 days). Conclusions The observed risk for VTE in COVID-19 is high, particularly in ICU patients, which should lead to a high level of clinical suspicion and low threshold for diagnostic imaging for DVT or PE. Future research should focus on optimal diagnostic and prophylactic strategies to prevent VTE and potentially improve survival.