Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY.
Division of Vascular Surgery, Department of Surgery, Mount Sinai Hospital, New York, NY.
J Vasc Surg. 2021 Mar;73(3):789-796. doi: 10.1016/j.jvs.2020.08.038. Epub 2020 Sep 1.
Coronavirus disease 2019 (COVID-19) is a novel coronavirus that has typically resulted in upper respiratory symptoms. However, we have encountered acute arterial and venous thrombotic events after COVID-19 infection. Managing acute thrombotic events from the novel virus has presented unprecedented challenges during the COVID-19 pandemic. In our study, we have highlighted the unique treatment required for these patients and discussed the role of anticoagulation for patients diagnosed with COVID-19.
The data from 21 patients with laboratory-confirmed COVID-19 disease and acute venous or arterial thrombosis were collected. The demographics, comorbidities, home medications, laboratory markers, and outcomes were analyzed. The primary postoperative outcome of interest was mortality, and the secondary outcomes were primary patency and morbidity. To assess for significance, a univariate analysis was performed using the Pearson χ and Fisher exact tests for categorical variables and the Student t test for continuous variables.
A total of 21 patients with acute thrombotic events met our inclusion and exclusion criteria. Most cases were acute arterial events (76.2%), with the remainder venous cases (23.8%). The average age for all patients was 64.6 years, and 52.4% were male. The most prevalent comorbidity in the group was hypertension (81.0%). Several markers were markedly abnormal in both arterial and venous cases, including an elevated neutrophil/lymphocyte ratio (8.8) and D-dimer level (4.9 μg/mL). Operative intervention included percutaneous angiography in 25.00% of patients and open surgical embolectomy in 23.8%. Most of the patients who had undergone arterial intervention had developed a postoperative complication (53.9%) compared with a 0% complication rate after venous interventions. Acute kidney injury on admission was a factor in 75.0% of those who died vs 18.2% in the survivors (P = .04).
We have described our experience in the epicenter of the pandemic of 21 patients who had experienced major thrombotic events from infection with COVID-19. The findings from our cohort have highlighted the need for increased awareness of the vascular manifestations of COVID-19 and the important role of anticoagulation for these patients. More data are urgently needed to optimize treatment and prevent further vascular complications of COVID-19 infections.
新型冠状病毒 2019 型（COVID-19）是一种新型冠状病毒，通常导致上呼吸道症状。然而，我们在 COVID-19 感染后遇到了急性动静脉血栓形成事件。在 COVID-19 大流行期间，管理新型病毒引起的急性血栓形成事件带来了前所未有的挑战。在我们的研究中，我们强调了这些患者所需的独特治疗方法，并讨论了 COVID-19 患者抗凝治疗的作用。
收集了 21 例经实验室确诊的 COVID-19 疾病合并急性静脉或动脉血栓形成患者的数据。分析了患者的人口统计学、合并症、家庭用药、实验室标志物和结局。主要的术后结局是死亡率，次要结局是原发性通畅率和发病率。为了评估意义，使用 Pearson χ 和 Fisher 精确检验进行了单变量分析，用于分类变量，使用学生 t 检验用于连续变量。
共有 21 例急性血栓形成事件符合我们的纳入和排除标准。大多数病例为急性动脉事件（76.2%），其余为静脉病例（23.8%）。所有患者的平均年龄为 64.6 岁，52.4%为男性。该组最常见的合并症是高血压（81.0%）。动脉和静脉病例中均有多个标志物明显异常，包括中性粒细胞/淋巴细胞比值升高（8.8）和 D-二聚体水平升高（4.9μg/mL）。手术干预包括 25.00%的患者经皮血管造影和 23.8%的开放手术取栓。与静脉干预后 0%的并发症发生率相比，接受动脉干预的大多数患者发生了术后并发症（53.9%）。入院时急性肾损伤是死亡患者的一个因素（75.0%），而幸存者为 18.2%（P=.04）。
我们描述了我们在 COVID-19 大流行中心的 21 例患者经历的主要血栓形成事件的经验。我们的队列研究结果强调了需要提高对 COVID-19 血管表现的认识，以及抗凝治疗对这些患者的重要作用。迫切需要更多的数据来优化治疗并预防 COVID-19 感染的进一步血管并发症。
