Department of Pulmonary and Critical Care Medicine, Indiana University School of Medicine, Indianapolis, IN.
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN.
Crit Care Med. 2020 Sep;48(9):e805-e808. doi: 10.1097/CCM.0000000000004472.
One of the defining features of the novel coronavirus disease 2019 infection has been high rates of venous thromboses. The present study aimed to describe the prevalence of venous thromboembolism in critically ill patients receiving different regimens of prophylactic anticoagulation.
Single-center retrospective review using data from patients with confirmed severe acute respiratory syndrome coronavirus 2 requiring intubation.
Tertiary-care center in Indianapolis, IN, United States.
Patients hospitalized at international units Health Methodist Hospital with severe acute respiratory syndrome coronavirus 2 requiring intubation between March 23, 2020, and April 8, 2020, who underwent ultrasound evaluation for venous thrombosis.
None.
A total of 45 patients were included. Nineteen of 45 patients (42.2%) were found to have deep venous thrombosis. Patients found to have deep venous thrombosis had no difference in time to intubation (p = 0.97) but underwent ultrasound earlier in their hospital course (p = 0.02). Sequential Organ Failure Assessment scores were similar between the groups on day of intubation and day of ultrasound (p = 0.44 and p = 0.07, respectively). D-dimers were markedly higher in patients with deep venous thrombosis, both for maximum value and value on day of ultrasound (p < 0.01 for both). Choice of prophylactic regimen was not related to presence of deep venous thrombosis (p = 0.35). Ultrasound evaluation is recommended if D-dimer is greater than 2,000 ng/mL (sensitivity 95%, specificity 46%) and empiric anticoagulation considered if D-dimer is greater than 5,500 ng/mL (sensitivity 53%, specificity 88%).
Deep venous thrombosis is very common in critically ill patients with coronavirus disease 2019. There was no difference in incidence of deep venous thrombosis among different pharmacologic prophylaxis regimens, although our analysis is limited by small sample size. D-dimer values are elevated in the majority of these patients, but there may be thresholds at which screening ultrasound or even empiric systemic anticoagulation is indicated.
新型冠状病毒病 2019 感染的一个显著特征是静脉血栓形成的发生率较高。本研究旨在描述接受不同预防抗凝治疗方案的重症患者静脉血栓栓塞的发生率。
使用确诊为需要插管的严重急性呼吸综合征冠状病毒 2 的患者数据进行的单中心回顾性研究。
美国印第安纳波利斯市三级保健中心国际单位健康卫理公会医院。
2020 年 3 月 23 日至 2020 年 4 月 8 日期间因严重急性呼吸综合征冠状病毒 2 需要插管而住院于国际单位健康卫理公会医院的患者，并对其进行静脉血栓形成的超声评估。
无。
共纳入 45 例患者。45 例患者中 19 例（42.2%）发现深静脉血栓形成。有深静脉血栓形成的患者在插管时间上没有差异（p = 0.97），但在住院期间较早进行了超声检查（p = 0.02）。两组患者在插管日和超声日的序贯器官衰竭评估评分相似（p = 0.44 和 p = 0.07）。深静脉血栓形成患者的 D-二聚体均明显升高，最大值和超声日的值均升高（p < 0.01）。预防方案的选择与深静脉血栓形成无关（p = 0.35）。如果 D-二聚体大于 2000 ng/mL，则推荐进行超声评估（敏感性 95%，特异性 46%），如果 D-二聚体大于 5500 ng/mL，则考虑经验性抗凝治疗（敏感性 53%，特异性 88%）。
重症 2019 冠状病毒病患者中深静脉血栓形成非常常见。不同药物预防方案的深静脉血栓形成发生率无差异，尽管我们的分析受到样本量小的限制。这些患者中的大多数 D-二聚体值升高，但可能存在提示进行筛查超声检查甚至经验性全身抗凝治疗的阈值。
