Postdischarge venous thromboembolism following hospital admission with COVID-19
Postdischarge venous thromboembolism following hospital admission with COVID-19
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DOI：
10.1182/blood.2020008086
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发表时间：
2020-09-10
期刊：
影响因子：
20.3
通讯作者：
Arya, Roopen
中科院分区：
文献类型：
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作者：
Roberts, Lara N.;Whyte, Martin B.;Arya, Roopen
2019年严重冠状病毒病（COVID-19）与静脉血栓栓塞（VTE）风险增加的相关性导致了其预防和管理的具体指南。静脉血栓栓塞的风险似乎最高的那些与重症监护入院。出院后血栓预防的必要性仍然存在争议，这反映在相互矛盾的专家指南建议中。我们的当地方案仅在住院期间为COVID-19患者提供血栓预防。我们报告出院后静脉血栓栓塞的数据，从一个正在进行的质量改进计划，包括根本原因分析医院相关性静脉血栓栓塞（HA-VTE）。在1877例与COVID-19相关的出院后，42天内诊断出9例HA-VTE发作，出院后发生率为每1000例出院病例中4.8例。在2019年，在18159次与医疗入院相关的出院后，42天内有56次HA-VTE发作（每1000次出院中有3.1次）。与2019年相比，与COVID-19相关的出院后HA-VTE的比值比为1.6（95%置信区间，0.77-3.1）。与其他急性内科疾病住院相比，COVID-19住院似乎不会增加出院后HA-VTE的风险。鉴于出院后血栓预防的风险受益比仍不确定，需要进行随机对照试验，以评估出院后COVID-19患者继续血栓预防的作用。
The association of severe coronavirus disease 2019 (COVID-19) with an increased risk of venous thromboembolism (VTE) has resulted in specific guidelines for its prevention and management. The VTE risk appears highest in those with critical care admission. The need for postdischarge thromboprophylaxis remains controversial, which is reflected in conflicting expert guideline recommendations. Our local protocol provides thromboprophylaxis to COVID-19 patients during admission only. We report postdischarge VTE data from an ongoing quality improvement program incorporating root-cause analysis of hospital-associated VTE (HA-VTE). Following 1877 hospital discharges associated with COVID-19, 9 episodes of HA-VTE were diagnosed within 42 days, giving a postdischarge rate of 4.8 per 1000 discharges. Over 2019, following 18 159 discharges associated with a medical admission; there were 56 episodes of HA-VTE within 42 days (3.1 per 1000 discharges). The odds ratio for postdischarge HA-VTE associated with COVID-19 compared with 2019 was 1.6 (95% confidence interval, 0.77-3.1). COVID-19 hospitalization does not appear to increase the risk of postdischarge HA-VTE compared with hospitalization with other acute medical illness. Given that the risk-benefit ratio of postdischarge thromboprophylaxis remains uncertain, randomized controlled trials to evaluate the role of continuing thromboprophylaxis in COVID-19 patients following hospital discharge are required.