Birkeland Kade, Zimmer Raymond, Kimchi Asher, Kedan Ilan
Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Smidt Cedars-Sinai Heart Institute, Beverly Hills, CA, United States.
Interact J Med Res. 2020 Sep 1;9(3):e22768. doi: 10.2196/22768.
Coagulopathy associated with COVID-19 infection and venous thromboembolism (VTE) have emerged as significant contributors to morbidity among patients infected with SARS-CoV-2.
We performed a systematic review to estimate VTE incidence in hospitalized patients and to analyze characteristic factors in the VTE cohort.
We searched PubMed and Google Scholar using specified title search terms "SARS-CoV-2" or "COVID-19" and "venous thromboembolism" and "anticoagulation" among others to identify peer-reviewed journal articles published between June 22, 2019, and June 22, 2020. Data were systematically extracted and synthesized using Microsoft Excel for analysis. The main outcome was VTE incidence, and measures included patient characteristics, anticoagulation, and clinical outcomes with assessment for associations.
In total, 14 studies were included comprising 1677 patients. Most patients (n=1306, 82.4%) received anticoagulation (either VTE prophylaxis or treatment). VTE incidence was 26.9% (SE 3.1; 95% CI 20.8-33.1) and was correlated with systematic screening (r=0.34, P=.03) and study duration (r=-0.33, P=.03). D-dimer was higher for the VTE cohort (5.62 [SD 0.9] vs 1.43 [SD 0.6]; P<.001). Odds of VTE were higher at the intensive care unit (odds ratio [OR] 6.38, 95% CI 3.67-11.11; P<.001) but lower with anticoagulation (OR 0.58, 95% CI 0.36-0.92; P=.02).
Despite the utilization of background anticoagulation, VTE incidence was historically high. Future studies are needed to provide additional data to guide optimal VTE prophylaxis and diagnostic strategies.
与新型冠状病毒肺炎（COVID-19）感染相关的凝血功能障碍和静脉血栓栓塞症（VTE）已成为严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染患者发病的重要因素。
我们进行了一项系统评价，以估计住院患者的VTE发生率，并分析VTE队列中的特征因素。
我们在PubMed和谷歌学术上搜索，使用指定的标题搜索词“SARS-CoV-2”或“COVID-19”以及“静脉血栓栓塞症”和“抗凝”等，以识别2019年6月22日至2020年6月22日期间发表的同行评审期刊文章。使用Microsoft Excel系统地提取和综合数据进行分析。主要结果是VTE发生率，测量指标包括患者特征、抗凝情况以及评估相关性的临床结果。
总共纳入了14项研究，包括1677名患者。大多数患者（n = 1306，82.4%）接受了抗凝治疗（VTE预防或治疗）。VTE发生率为26.9%（标准误3.1；95%置信区间20.8 - 33.1），与系统筛查（r = 0.34，P = 0.03）和研究持续时间（r = -0.33，P = 0.03）相关。VTE队列的D-二聚体水平更高（5.62 [标准差0.9] 对比1.43 [标准差0.6]；P < 0.001）。在重症监护病房VTE发生几率更高（优势比[OR] 6.38，95%置信区间3.67 - 11.11；P < 0.001），但抗凝治疗后发生几率更低（OR 0.58，95%置信区间0.36 - 0.92；P = 0.02）。
尽管使用了背景抗凝治疗，但VTE发生率一直处于历史高位。未来需要开展更多研究以提供额外数据，指导最佳VTE预防和诊断策略。
