Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study
Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study
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DOI：
10.1186/s13054-020-03260-3
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发表时间：
2020-09-18
期刊：
影响因子：
15.1
通讯作者：
McKechnie, Stuart R.
中科院分区：
文献类型：
--
作者：
Shah, Akshay;Donovan, Killian;McKechnie, Stuart R.
背景资料：COVID-19患者血栓栓塞性疾病的最佳预防和治疗管理仍然是临床医生面临的主要挑战。本研究的目的是确定COVID-19重症患者血栓形成和出血并发症的发生率。此外，我们试图使用血栓弹性描记术来验证凝血特征，并探索有和无血栓并发症患者之间可能的生物学差异。方法：我们进行了一项多中心回顾性观察性研究，评估了2020年3月15日至2020年5月5日期间在英国四家三级医院的四个重症监护室（ICU）接受的所有COVID-19患者。临床特征，实验室数据，血栓弹力图的配置文件和临床结果数据进行了评价患者和无血栓并发症。他们的中位（四分位数（IQR））年龄为57（49-64）岁，124例（66.3%）患者为男性。81例（43.3%）患者发生了一种或多种临床相关血栓性并发症，主要是肺栓塞（n = 42（22.5%））。25例（13.3%）患者报告了动脉栓塞并发症。与无血栓并发症的患者相比，有血栓并发症的患者在ICU的住院时间更长。15例（8.0%）患者发生出血并发症，其中9例（4.8%）被归类为大出血。血栓弹力图显示高凝状态的患者测试，但缺乏区分价值之间的血栓性并发症和没有。发生血栓性并发症的患者在ICU入院时的D-二聚体、铁蛋白、肌钙蛋白和白色细胞计数水平高于未发生血栓性并发症的患者。出血发生率可能高于先前报告的发生率，因此需要进行随机试验，以更好地了解不同抗凝策略的风险-获益比。
Background: Optimal prophylactic and therapeutic management of thromboembolic disease in patients with COVID-19 remains a major challenge for clinicians. The aim of this study was to define the incidence of thrombotic and haemorrhagic complications in critically ill patients with COVID-19. In addition, we sought to characterise coagulation profiles using thromboelastography and explore possible biological differences between patients with and without thrombotic complications.Methods: We conducted a multicentre retrospective observational study evaluating all the COVID-19 patients received in four intensive care units (ICUs) of four tertiary hospitals in the UK between March 15, 2020, and May 05, 2020. Clinical characteristics, laboratory data, thromboelastography profiles and clinical outcome data were evaluated between patients with and without thrombotic complications.Results: A total of 187 patients were included. Their median (interquartile (IQR)) age was 57 (49-64) years and 124 (66.3%) patients were male. Eighty-one (43.3%) patients experienced one or more clinically relevant thrombotic complications, which were mainly pulmonary emboli (n = 42 (22.5%)). Arterial embolic complications were reported in 25 (13.3%) patients. ICU length of stay was longer in patients with thrombotic complications when compared with those without. Fifteen (8.0%) patients experienced haemorrhagic complications, of which nine (4.8%) were classified as major bleeding. Thromboelastography demonstrated a hypercoagulable profile in patients tested but lacked discriminatory value between those with and without thrombotic complications. Patients who experienced thrombotic complications had higher D-dimer, ferritin, troponin and white cell count levels at ICU admission compared with those that did not.Conclusion: Critically ill patients with COVID-19 experience high rates of venous and arterial thrombotic complications. The rates of bleeding may be higher than previously reported and re-iterate the need for randomised trials to better understand the risk-benefit ratio of different anticoagulation strategies.