Frequency of venous thromboembolism in 6513 patients with COVID-19: a retrospective study.
Frequency of venous thromboembolism in 6513 patients with COVID-19: a retrospective study.
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DOI：
10.1182/bloodadvances.2020003083
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发表时间：
2020-11-10
期刊：
影响因子：
7.5
通讯作者：
Deitelzweig S
中科院分区：
文献类型：
--
作者：
Hill JB;Garcia D;Crowther M;Savage B;Peress S;Chang K;Deitelzweig S
在路易斯安那州新奥尔良市的一个大型队列中，VTE的发病率与之前的住院人群没有差异。值得注意的透析血栓形成的大亚群可能是与典型VTE无关的血栓形成发生率高的原因。感染严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）的患者发生静脉血栓栓塞（VTE）的风险似乎会增加，特别是如果他们因COVID-19而病情危重。一些中心报告了非常高的血栓形成率，尽管抗凝剂预防。对新奥尔良卫生系统的电子健康记录（EHR）进行了检索，以查找2020年3月1日至2020年5月1日期间入院或接受治疗并从急诊科出院的所有经聚合酶链反应确认的SARS-CoV-2感染患者。从该队列中，通过EHR的管理查询确定确诊VTE的患者（在医院就诊期间或之后）。2020年3月1日至2020年5月1日，共确诊6153名COVID-19患者;其中2748名患者入院，3405名患者仅通过急诊科接受治疗。总共有637名患者需要机械通气，206名患者需要肾脏替代治疗。在住院队列中，总死亡率为24.5%，86例患者（3.1%）发生VTE。在637例住院期间需要机械通气的患者中，45例发生了VTE（7.2%）。在中位随访14.6天后，2075例住院患者中有3例（0.14%）被诊断为VTE。在6153名住院或在急诊科接受治疗的COVID-19患者中，我们没有发现VTE风险异常高的证据。在等待来自前瞻性对照试验的进一步证据之前，我们的研究结果支持COVID-19患者的一级VTE预防的传统方法。
VTE incidence for a large cohort in New Orleans, LA, does not differ from previous hospitalized populations matched for acuity. Noted large subpopulation of dialysis thrombosis may account for high incidence of thrombosis not related to typical VTE. Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appear to be at increased risk for venous thromboembolism (VTE), especially if they become critically ill with COVID-19. Some centers have reported very high rates of thrombosis despite anticoagulant prophylaxis. The electronic health record (EHR) of a New Orleans–based health system was searched for all patients with polymerase chain reaction–confirmed SARS-CoV-2 infection who were either admitted to hospital or treated and discharged from an emergency department between 1 March 2020 and 1 May 2020. From this cohort, patients with confirmed VTE (either during or after their hospital encounter) were identified by administrative query of the EHR.: Between 1 March 2020 and 1 May 2020, 6153 patients with COVID-19 were identified; 2748 of these patients were admitted, while 3405 received care exclusively through the emergency department. In total, 637 patients required mechanical ventilation and 206 required renal replacement therapy. Within the hospitalized cohort, the overall mortality rate was 24.5% and VTE occurred in 86 patients (3.1%). In the 637 patients who required mechanical ventilation at some point during their hospital stay, 45 developed VTE (7.2%). After a median follow-up of 14.6 days, VTE had been diagnosed in 3 of the 2075 admitted who were discharged alive (0.14%). Among 6153 patients with COVID-19 who were hospitalized or treated in emergency departments, we did not find evidence of unusually high VTE risk. Pending further evidence from prospective, controlled trials, our findings support a traditional approach to primary VTE prevention in patients with COVID-19.
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