Risk of Clinically Relevant Venous Thromboembolism in Critically Ill Patients With COVID-19: A Systematic Review and Meta-Analysis.
Risk of Clinically Relevant Venous Thromboembolism in Critically Ill Patients With COVID-19: A Systematic Review and Meta-Analysis.
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DOI：
10.3389/fmed.2021.647917
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发表时间：
2021
影响因子：
3.9
通讯作者：
Schaden E
中科院分区：
文献类型：
--
作者：
Gratz J;Wiegele M;Maleczek M;Herkner H;Schöchl H;Chwala E;Knöbl P;Schaden E
背景：在正在进行的新冠肺炎大流行的早期，报告表明新冠肺炎危重患者血栓栓子事件的发生率高得惊人。然而，这些事件的临床相关性在几项研究中没有报道。此外，最近的研究显示了相互矛盾的结果，并表明静脉血栓栓塞率大大降低。因此，本研究的目的是总结有关新冠肺炎成人危重患者发生临床相关静脉血栓栓塞症的证据。静脉血栓栓塞症定义为不包括孤立的亚段肺栓塞(PE)和远端深静脉血栓形成(DVT)的静脉血栓形成。方法：我们对新冠肺炎危重患者发生临床相关PE和/或DVT的研究进行了系统综述。其中包括2020年1月至10月发表的英文版科学报告。我们进行了随机效应模型荟萃分析，以计算与临床相关的VTE和出血事件的发生率估计。我们还对不同的诊断方法和可能影响这些结果发生率的其他因素进行了探索性的Meta回归和亚组分析。结果：54篇文章(5400名患者)符合预先定义的纳入标准，其中41篇有较高的偏倚风险。纳入的大多数患者是男性，年龄60岁，超重。21项研究报告了预防性剂量的肝素的使用。临床相关的PE的合并发生率估计为8%(95%可信区间，4-11%)，近端深静脉血栓的合并发病率为14%(95%可信区间，9-20%)，排除高偏见风险的研究后，静脉血栓栓塞的综合结果为18%(95%可信区间，13-24%)。临床相关出血发生率为6%(95%可信区间为2-9%)。结论：我们总结了目前有关新冠肺炎危重患者临床相关静脉血栓栓塞率的现有数据。合并发病率估计低于以前综述文章所报道的。在缺乏新冠肺炎危重患者的循证抗凝指南的情况下，我们的研究结果为这方面的个体风险-收益评估提供了重要的临床信息。注册：该研究方案于2020年6月22日在普罗斯佩罗注册(CRD42020193353；https://www.crd.york.ac.uk/prospero).
Background: Early during the course of the ongoing COVID-19 pandemic, reports suggested alarmingly high incidences for thromboembolic events in critically ill patients with COVID-19. However, the clinical relevance of these events was not reported in several studies. Additionally, more recent research showed contradictory results and suggested substantially lower rates of venous thromboembolism. Thus, the aim of the present study was to summarize evidence on the incidence of clinically relevant venous thromboembolism (VTE)—defined as VTE excluding isolated subsegmental pulmonary embolism (PE) and distal deep vein thrombosis (DVT)—in adult critically ill patients with COVID-19. Methods: We performed a systematic review of studies reporting the incidence of clinically relevant PE and/or DVT in critically ill patients with COVID-19. Scientific reports published in the English language between January and October 2020 were included. We conducted a random-effects model meta-analysis to calculate incidence estimates of clinically relevant VTE and bleeding events. We also performed exploratory meta-regression and subgroup analyses of different diagnostic approaches and additional factors that possibly influenced the incidence of these outcomes. Results: Fifty-four articles (5,400 patients) fulfilled the predefined inclusion criteria, of which 41 had a high risk of bias. The majority of included patients were male, > 60 years, and overweight. Twenty-one studies reported the use of prophylactic doses of heparin. Pooled incidences for clinically relevant PE were estimated at 8% (95% CI, 4–11%), for proximal DVT at 14% (95% CI, 9–20%), and—after exclusion of studies with a high risk of bias—for the composite outcome of VTE at 18% (95% CI, 13–24%). Clinically relevant bleeding occurred at a rate of 6% (95% CI, 2–9%). Conclusions: We summarized currently available data on the rate of clinically relevant VTE in critically ill patients with COVID-19. Pooled incidence estimates were lower than those reported by previous review articles. In the absence of evidence-based anticoagulation guidelines for critically ill patients with COVID-19, the results of our study provide clinically important information for an individual risk-benefit assessment in this context. Registration: The study protocol was prospectively registered in PROSPERO on June 22, 2020 (CRD42020193353; https://www.crd.york.ac.uk/prospero).
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DOI：
10.1111/jth.14849
发表时间：
2020-07
期刊：
Journal of thrombosis and haemostasis : JTH
影响因子：
--
作者：
通讯作者：
--
影响因子：
3.7
作者：
Aleva, F. E.;van Mourik, L.;de Jager, C. P. C.
通讯作者：
de Jager, C. P. C.
影响因子：
4
作者：
Barnes, Geoffrey D.;Burnett, Allison;Minichiello, Tracy
通讯作者：
Minichiello, Tracy
COVID-19危重患者的 DVT 发生率和危险因素
影响因子：
4
作者：
Chen, Shujing;Zhang, Dingyu;Jiang, Jinjun
通讯作者：
Jiang, Jinjun
影响因子：
10.4
作者：
Cui, Songping;Chen, Shuo;Wang, Feng
通讯作者：
Wang, Feng