Factors Associated With Risk of Postdischarge Thrombosis in Patients With COVID-19.
Factors Associated With Risk of Postdischarge Thrombosis in Patients With COVID-19.
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DOI：
10.1001/jamanetworkopen.2021.35397
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发表时间：
2021-11-01
影响因子：
13.8
通讯作者：
Poisson L
中科院分区：
文献类型：
--
作者：
Li P;Zhao W;Kaatz S;Latack K;Schultz L;Poisson L
哪些COVID-19患者可能受益于出院后延长的血栓预防？在2832例新冠肺炎住院患者的队列研究中，有静脉血栓栓塞史、峰值二聚体纤溶酶片段D （D-二聚体）水平大于3 μg/mL、出院前c反应蛋白水平大于10 mg/dL的患者出院后静脉血栓栓塞事件发生率更高。出院后接受抗凝治疗的患者事件较少。提示高危患者出院后可考虑抗凝治疗。本队列研究确定了与出院后静脉血栓栓塞风险相关的因素，并评估了COVID-19患者出院后抗凝使用与静脉血栓栓塞发生率的关系。COVID-19与血栓形成事件的高发有关；然而，住院后是否需要延长血栓预防仍不清楚。量化COVID-19患者出院后动脉和静脉血栓栓塞发生率，明确出院后静脉血栓栓塞风险相关因素，评价出院后抗凝使用与静脉血栓栓塞发生率的相关性。这是一项针对SARS-CoV-2检测阳性的成年COVID-19住院患者的队列研究。符合条件的患者于2020年3月1日至11月30日在亨利福特卫生系统的5家医院登记。数据分析时间为2021年4月至6月。出院后抗凝治疗。采用《国际疾病与相关健康问题统计分类》第十版代码对COVID-19感染指数入院出院后90天内新发有症状的动脉和静脉血栓栓塞事件进行鉴定。在该队列研究中，2832例成年COVID-19住院患者的平均（SD）年龄为63.4（16.7）岁（IQR， 53-75岁），男性1347例（47.6%）。36例（1.3%）患者发生出院后静脉血栓栓塞事件（肺栓塞16例，深静脉血栓18例，门静脉血栓2例）。出院后动脉血栓栓塞事件15例（0.5%）（1例短暂性脑缺血发作，14例急性冠状动脉综合征）。静脉血栓栓塞的风险随时间的延长而降低(Mann-Kendall趋势检验，P <。001)，到事件发生的中位（IQR）时间为16（7-43）天。动脉血栓栓塞的风险没有随时间变化(Mann-Kendall趋势检验，P =。37)，发生事件的中位（IQR）时间为37（10-63）天。静脉血栓栓塞史（优势比[OR]， 3.24; 95% CI, 1.34-7.86）、峰值二聚体纤溶酶片段D （D-二聚体）水平大于3 μg/mL （OR, 3.76; 95% CI, 1.86-7.57）、出院前c反应蛋白水平大于10 mg/dL （OR, 3.02; 95% CI, 1.45-6.29）的患者出院后更容易发生静脉血栓栓塞。出院时抗凝治疗处方与静脉血栓栓塞发生率降低相关（OR, 0.18; 95% CI, 0.04-0.75; P = 0.02）。虽然不支持在未选择的COVID-19患者中扩大血栓预防，但这些研究结果表明，对于有静脉血栓栓塞史、峰值d -二聚体水平大于3 μg/mL、出院前c反应蛋白水平大于10 mg/dL的高危患者，如果出血风险较低，可以考虑出院后抗凝。
Which patients with COVID-19 may benefit from extended thromboprophylaxis following hospital discharge? In this cohort study of 2832 patients hospitalized with COVID-19, postdischarge venous thromboembolic events occurred more often in those with a history of venous thromboembolism, peak dimerized plasmin fragment D (D-dimer) level greater than 3 μg/mL, and predischarge C-reactive protein level greater than 10 mg/dL. Patients who received postdischarge anticoagulation therapy had fewer events. These findings suggest that postdischarge anticoagulation therapy may be considered for high-risk patients with COVID-19. This cohort study identifies the factors associated with risk of postdischarge venous thromboembolism and evaluates the association of postdischarge anticoagulation use with venous thromboembolism incidence among patients with COVID-19. COVID-19 is associated with a high incidence of thrombotic events; however, the need for extended thromboprophylaxis after hospitalization remains unclear. To quantify the rate of postdischarge arterial and venous thromboembolism in patients with COVID-19, identify the factors associated with the risk of postdischarge venous thromboembolism, and evaluate the association of postdischarge anticoagulation use with venous thromboembolism incidence. This is a cohort study of adult patients hospitalized with COVID-19 confirmed by a positive SARS-CoV-2 test. Eligible patients were enrolled at 5 hospitals of the Henry Ford Health System from March 1 to November 30, 2020. Data analysis was performed from April to June 2021. Anticoagulant therapy after discharge. New onset of symptomatic arterial and venous thromboembolic events within 90 days after discharge from the index admission for COVID-19 infection were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. In this cohort study of 2832 adult patients hospitalized with COVID-19, the mean (SD) age was 63.4 (16.7) years (IQR, 53-75 years), and 1347 patients (47.6%) were men. Thirty-six patients (1.3%) had postdischarge venous thromboembolic events (16 pulmonary embolism, 18 deep vein thrombosis, and 2 portal vein thrombosis). Fifteen (0.5%) postdischarge arterial thromboembolic events were observed (1 transient ischemic attack and 14 acute coronary syndrome). The risk of venous thromboembolism decreased with time (Mann-Kendall trend test, P < .001), with a median (IQR) time to event of 16 (7-43) days. There was no change in the risk of arterial thromboembolism with time (Mann-Kendall trend test, P = .37), with a median (IQR) time to event of 37 (10-63) days. Patients with a history of venous thromboembolism (odds ratio [OR], 3.24; 95% CI, 1.34-7.86), peak dimerized plasmin fragment D (D-dimer) level greater than 3 μg/mL (OR, 3.76; 95% CI, 1.86-7.57), and predischarge C-reactive protein level greater than 10 mg/dL (OR, 3.02; 95% CI, 1.45-6.29) were more likely to experience venous thromboembolism after discharge. Prescriptions for therapeutic anticoagulation at discharge were associated with reduced incidence of venous thromboembolism (OR, 0.18; 95% CI, 0.04-0.75; P = .02). Although extended thromboprophylaxis in unselected patients with COVID-19 is not supported, these findings suggest that postdischarge anticoagulation may be considered for high-risk patients who have a history of venous thromboembolism, peak D-dimer level greater than 3 μg/mL, and predischarge C-reactive protein level greater than 10 mg/dL, if their bleeding risk is low.
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影响因子：
20.3
作者：
Giannis D;Allen SL;Tsang J;Flint S;Pinhasov T;Williams S;Tan G;Thakur R;Leung C;Snyder M;Bhatia C;Garrett D;Cotte C;Isaacs S;Gugerty E;Davidson A;Marder GS;Schnitzer A;Goldberg B;McGinn T;Davidson KW;Barish MA;Qiu M;Zhang M;Goldin M;Matsagkas M;Arnaoutoglou E;Spyropoulos AC
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158.5
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影响因子：
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影响因子：
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作者：
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