Division of Hematology and.
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Blood. 2020 Sep 10;136(11):1342-1346. doi: 10.1182/blood.2020007938.
Coronavirus disease 2019 (COVID-19) is associated with a prothrombotic state with a high incidence of thrombotic events during hospitalization; however, data examining rates of thrombosis after discharge are limited. We conducted a retrospective observational cohort study of discharged patients with confirmed COVID-19 not receiving anticoagulation. The cohort included 163 patients with median time from discharge to last recorded follow-up of 30 days (interquartile range [IQR], 17-46 days). The median duration of index hospitalization was 6 days (IQR, 3-12 days) and 26% required intensive care. The cumulative incidence of thrombosis (including arterial and venous events) at day 30 following discharge was 2.5% (95% confidence interval [CI], 0.8-7.6); the cumulative incidence of venous thromboembolism alone at day 30 postdischarge was 0.6% (95% CI, 0.1-4.6). The 30-day cumulative incidence of major hemorrhage was 0.7% (95% CI, 0.1-5.1) and of clinically relevant nonmajor bleeds was 2.9% (95% CI, 1.0-9.1). We conclude that the rates of thrombosis and hemorrhage appear to be similar following hospital discharge for COVID-19, emphasizing the need for randomized data to inform recommendations for universal postdischarge thromboprophylaxis.
2019 年冠状病毒病（COVID-19）与促血栓形成状态相关，住院期间血栓事件的发生率较高；然而，关于出院后血栓形成率的数据有限。我们对未接受抗凝治疗的出院确诊 COVID-19 患者进行了回顾性观察性队列研究。该队列包括 163 名患者，从出院到最后一次记录随访的中位时间为 30 天（四分位距 [IQR]，17-46 天）。指数住院的中位时间为 6 天（IQR，3-12 天），26%需要重症监护。出院后第 30 天血栓形成（包括动脉和静脉事件）的累积发生率为 2.5%（95%置信区间 [CI]，0.8-7.6）；出院后第 30 天单纯静脉血栓栓塞的累积发生率为 0.6%（95%CI，0.1-4.6）。30 天主要出血的累积发生率为 0.7%（95%CI，0.1-5.1），临床相关非大出血的累积发生率为 2.9%（95%CI，1.0-9.1）。我们的结论是，COVID-19 患者出院后血栓形成和出血的发生率似乎相似，这强调需要随机数据来为普遍的出院后血栓预防提供建议。
