High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study
High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study
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DOI：
10.1007/s00134-020-06062-x
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发表时间：
2020-05-04
影响因子：
38.9
通讯作者：
Meziani, Ferhat
中科院分区：
文献类型：
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作者：
Helms, Julie;Tacquard, Charles;Meziani, Ferhat
目的：很少有证据表明COVID-19患者血栓形成风险增加。我们的目的是评估严重形式的SARS-CoV-2感染的血栓形成风险。方法收集2020年3月3日至31日在法国某三级医院2个中心4个重症监护病房（icu）收治的2019冠状病毒病急性呼吸窘迫综合征（ARDS）患者。前瞻性地收集病史、症状、生物学资料和影像学资料。采用倾向评分匹配分析非COVID-19 ARDS和COVID-19 ARDS患者血栓栓塞事件的发生情况。结果纳入新冠肺炎患者150例（男性122例，中位年龄63[53；71]岁，SAPSII 49[37； 64]分）。在150例患者中诊断出64例临床相关血栓性并发症，主要是肺栓塞（16.7%）。29例接受持续肾替代治疗的患者中有28例（96.6%）出现循环凝血。12例（8%）经ECMO支持的患者发生3例（2例）离心泵血栓闭塞。大多数患者（95%）d -二聚体和纤维蛋白原升高。无患者发生弥漫性血管内凝血。血管性血友病（vWF）活性、vWF抗原和FVIII明显升高，50/57例（87.7%）狼疮抗凝血剂阳性。与非COVID-19 ARDS患者（n = 145）比较，证实COVID-19 ARDS患者（n = 77）出现明显更多的血栓性并发症，主要是肺栓塞（11.7% vs. 2.1%, p < 0.008）。两组间凝血参数差异有统计学意义。结论尽管进行了抗凝治疗，但仍有大量继发于COVID-19的ARDS患者出现危及生命的血栓性并发症。因此，可能建议高于一般危重病人的抗凝目标。
Purpose Little evidence of increased thrombotic risk is available in COVID-19 patients. Our purpose was to assess thrombotic risk in severe forms of SARS-CoV-2 infection. Methods All patients referred to 4 intensive care units (ICUs) from two centers of a French tertiary hospital for acute respiratory distress syndrome (ARDS) due to COVID-19 between March 3rd and 31st 2020 were included. Medical history, symptoms, biological data and imaging were prospectively collected. Propensity score matching was performed to analyze the occurrence of thromboembolic events between non-COVID-19 ARDS and COVID-19 ARDS patients. Results 150 COVID-19 patients were included (122 men, median age 63 [53; 71] years, SAPSII 49 [37; 64] points). Sixty-four clinically relevant thrombotic complications were diagnosed in 150 patients, mainly pulmonary embolisms (16.7%). 28/29 patients (96.6%) receiving continuous renal replacement therapy experienced circuit clotting. Three thrombotic occlusions (in 2 patients) of centrifugal pump occurred in 12 patients (8%) supported by ECMO. Most patients (> 95%) had elevated D-dimer and fibrinogen. No patient developed disseminated intravascular coagulation. Von Willebrand (vWF) activity, vWF antigen and FVIII were considerably increased, and 50/57 tested patients (87.7%) had positive lupus anticoagulant. Comparison with non-COVID-19 ARDS patients (n = 145) confirmed that COVID-19 ARDS patients (n = 77) developed significantly more thrombotic complications, mainly pulmonary embolisms (11.7 vs. 2.1%, p < 0.008). Coagulation parameters significantly differed between the two groups. Conclusion Despite anticoagulation, a high number of patients with ARDS secondary to COVID-19 developed life-threatening thrombotic complications. Higher anticoagulation targets than in usual critically ill patients should therefore probably be suggested.