High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients
High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients
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DOI：
10.1111/jth.14869
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发表时间：
2020-05-27
影响因子：
10.4
通讯作者：
Merouani, Karim
中科院分区：
文献类型：
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作者：
Llitjos, Jean-Francois;Leclerc, Maxime;Merouani, Karim
背景凝血障碍是新冠肺炎患者的常见异常。然而，在抗凝的重症新冠肺炎患者中，静脉血栓事件的确切发生率尚不清楚。目的应用全双功超声对抗凝的新冠肺炎患者的静脉血栓栓塞症进行系统评估。患者和方法我们对2个法国重症监护病房进行了回顾性研究，其中以静脉血栓栓塞症为标准。对因新冠肺炎入院的患者在ICU期间早期进行大腿至踝部的彩色多普勒超声检查，并记录多普勒波形和图像。抗凝剂量由治疗医生根据个体血栓形成的风险自行决定。患者分为预防性抗凝治疗和治疗性抗凝治疗。结果2020年3月19日至4月11日，连续26例新冠肺炎重度患者进行了肺血栓栓塞症筛查。预防性抗凝治疗8例(31%)，治疗性抗凝治疗18例(69%)。患者VTE的总发生率为69%。接受预防性抗凝治疗的患者发生VTE的比例显著高于其他组(分别为100%和56%，P=0.03)。令人惊讶的是，我们在接受治疗性抗凝治疗的新冠肺炎患者中发现了很高的血栓栓塞率，56%的患者发生了静脉血栓栓塞症，6例患者发生了肺栓塞。结论我们的结果建议对重症ICU新冠肺炎患者同时进行系统的静脉血栓栓塞术的筛查和早期抗凝治疗。
Background Coagulopathy is a common abnormality in patients with COVID-19. However, the exact incidence of venous thromboembolic event is unknown in anticoagulated, severe COVID-19 patients.Objectives Systematic assessment of venous thromboembolism (VTE) using complete duplex ultrasound (CDU) in anticoagulated COVID-19 patients.Patients and methods We performed a retrospective study in 2 French intensive care units (ICU) where CDU is performed as a standard of care. A CDU from thigh to ankle at selected sites with Doppler waveforms and images was performed early during ICU stay in patients admitted with COVID-19. Anticoagulation dose was left to the discretion of the treating physician based on the individual risk of thrombosis. Patients were classified as treated with prophylactic anticoagulation or therapeutic anticoagulation. Pulmonary embolism was systematically searched in patients with persistent hypoxemia or secondary deterioration.Results From March 19 to April 11, 2020, 26 consecutive patients with severe COVID-19 were screened for VTE. Eight patients (31%) were treated with prophylactic anticoagulation, whereas 18 patients (69%) were treated with therapeutic anticoagulation. The overall rate of VTE in patients was 69%. The proportion of VTE was significantly higher in patients treated with prophylactic anticoagulation when compared with the other group (100% vs 56%, respectively, P = .03). Surprisingly, we found a high rate of thromboembolic events in COVID-19 patients treated with therapeutic anticoagulation, with 56% of VTE and 6 pulmonary embolisms.Conclusion Our results suggest considering both systematic screening of VTE and early therapeutic anticoagulation in severe ICU COVID-19 patients.