Zerwes Sebastian, Hernandez Cancino F, Liebetrau D, Gosslau Y, Warm T, Märkl B, Hyhlik-Dürr A
Gefäßchirurgie und endovaskuläre Chirurgie, Medizinische Fakultät, Universität Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.
Allgemeine und Spezielle Pathologie, Medizinische Fakultät, Universität Augsburg, Augsburg, Deutschland.
Chirurg. 2020 Jul;91(7):588-594. doi: 10.1007/s00104-020-01222-7.
The incidence of deep vein thrombosis (DVT) in CoViD-19 patients in intensive care units (ICU) has so far been investigated in only a few studies. Prospective comparative studies with non-CoViD-19 ICU patients are completely lacking.
Evaluation of the incidence of DVT in ICU patients with CoViD-19 compared to non-CoViD-19 ICU patients who were treated in the University Hospital Augsburg during the same period. In addition, the aim was to investigate what type of anticoagulation was present in CoViD-19 patients at the time the DVT occurred and to what extent DVT is associated with increased mortality in this patient population.
In this prospective single center study, which was conducted between 18 April 2020 and 30 April 2020, 20 SARS-CoV2 positive patients were compared with 20 non-CoVid-19 patients in the ICU with respect to the occurrence of DVT. For this purpose, demographic data, laboratory parameters, and clinical outcomes were recorded and evaluated.
The rate of DVT in the investigated patient collective was markedly higher in patients with SARS-CoV2 (CoViD-19 patients 20% vs. non-CoViD-19 patients 5%). Both DVT and elevated D‑dimer levels were associated with increased mortality in the present study.
We recommend the determination of D‑dimer levels and, in the case of elevated levels, the broad indication for compression sonography of the deep leg veins on admission of patients with suspected or confirmed SARS-CoV2. In this way DVT in the setting of CoViD-19 can be recognized early and therapeutic anticoagulation can be started. All inpatient CoViD-19 patients should receive thrombosis prophylaxis with low molecular weight heparin. Further studies on point of care methods (TEG®, ROTEM®) for the detection of hypercoagulability in SARS-CoV2 are necessary.
迄今为止，仅有少数研究调查了重症监护病房（ICU）中新冠肺炎患者深静脉血栓形成（DVT）的发生率。完全缺乏与非新冠肺炎ICU患者的前瞻性对照研究。
评估与同期在奥格斯堡大学医院接受治疗的非新冠肺炎ICU患者相比，新冠肺炎ICU患者中DVT的发生率。此外，目的是调查新冠肺炎患者发生DVT时的抗凝类型，以及DVT在该患者群体中与死亡率增加的关联程度。
在这项于2020年4月18日至2020年4月30日进行的前瞻性单中心研究中，将20例严重急性呼吸综合征冠状病毒2（SARS-CoV2）阳性患者与20例ICU中的非新冠肺炎患者在DVT发生情况方面进行了比较。为此，记录并评估了人口统计学数据、实验室参数和临床结局。
在所研究的患者群体中，SARS-CoV2患者（新冠肺炎患者20%，非新冠肺炎患者5%）的DVT发生率明显更高。在本研究中，DVT和D-二聚体水平升高均与死亡率增加相关。
我们建议测定D-二聚体水平，若水平升高，对于疑似或确诊SARS-CoV2的患者入院时应广泛推荐进行下肢深静脉加压超声检查。通过这种方式，可以早期识别新冠肺炎背景下的DVT并开始进行治疗性抗凝。所有住院的新冠肺炎患者都应接受低分子量肝素的血栓预防。有必要进一步研究用于检测SARS-CoV2高凝状态的床旁检测方法（血栓弹力图仪、旋转血栓弹力测定仪）。
