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COVID-19 住院患者静脉血栓栓塞症的临床表现、治疗模式和结局。

Presenting Characteristics, Treatment Patterns, and Outcomes among Patients with Venous Thromboembolism during Hospitalization for COVID-19.

机构信息

Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain.

Department of Internal Medicine, Hospital Rey Juan Carlos, Madrid, Spain.

出版信息

Semin Thromb Hemost. 2021 Jun;47(4):351-361. doi: 10.1055/s-0040-1718402. Epub 2020 Oct 21.

Abstract

Venous thromboembolism (VTE) is common in patients with coronavirus disease-2019 (COVID-19). However, limited data exist on patient characteristics, treatments, and outcomes. To describe the clinical characteristics, treatment patterns, and short-term outcomes of patients diagnosed with VTE during hospitalization for COVID-19. This is a prospective multinational study of patients with incident VTE during the course of hospitalization for COVID-19. Data were obtained from the (RIETE) registry. All-cause mortality, VTE recurrences, and major bleeding during the first 10 days were separately investigated for patients in hospital wards versus those in intensive care units (ICUs). As of May 03, 2020, a total number of 455 patients were diagnosed with VTE (83% pulmonary embolism, 17% isolated deep vein thrombosis) during their hospital stay; 71% were male, the median age was 65 (interquartile range, 55-74) years. Most patients (68%) were hospitalized in medical wards, and 145 in ICUs. Three hundred and seventeen (88%; 95% confidence interval [CI]: 84-91%) patients were receiving thromboprophylaxis at the time of VTE diagnosis. Most patients (88%) received therapeutic low-molecular-weight heparin, and 15 (3.6%) received reperfusion therapies. Among 420 patients with complete 10-day follow-up, 51 (12%; 95% CI: 9.3-15%) died, no patient recurred, and 12 (2.9%; 95% CI: 1.6-4.8%) experienced major bleeding. The 10-day mortality rate was 9.1% (95% CI: 6.1-13%) among patients in hospital wards and 19% (95% CI: 13-26%) among those in ICUs. This study provides characteristics and early outcomes of patients diagnosed with acute VTE during hospitalization for COVID-19. Additional studies are needed to identify the optimal strategies to prevent VTE and to mitigate adverse outcomes associated.

摘要

静脉血栓栓塞症(VTE)在 2019 年冠状病毒病(COVID-19)患者中很常见。然而,关于患者特征、治疗方法和结局的数据有限。描述 COVID-19 住院期间诊断为 VTE 的患者的临床特征、治疗模式和短期结局。这是一项针对 COVID-19 住院期间发生 VTE 的患者的前瞻性多国研究。数据来自 RIETE 登记处。分别调查住院病房和重症监护病房(ICU)患者住院期间的全因死亡率、VTE 复发和 10 天内主要出血情况。截至 2020 年 5 月 3 日,共有 455 例患者在住院期间诊断为 VTE(83%为肺栓塞,17%为孤立性深静脉血栓形成);71%为男性,中位年龄为 65 岁(四分位距,55-74 岁)。大多数患者(68%)在普通病房住院,145 例在 ICU 住院。317 例(88%;95%置信区间[CI]:84-91%)患者在 VTE 诊断时正在接受血栓预防治疗。大多数患者(88%)接受了治疗性低分子量肝素,15 例(3.6%)接受了再灌注治疗。在 420 例具有完整 10 天随访的患者中,51 例(12%;95%CI:9.3-15%)死亡,无患者复发,12 例(2.9%;95%CI:1.6-4.8%)发生主要出血。普通病房患者的 10 天死亡率为 9.1%(95%CI:6.1-13%),ICU 患者为 19%(95%CI:13-26%)。本研究提供了 COVID-19 住院期间诊断为急性 VTE 的患者的特征和早期结局。需要进一步研究以确定预防 VTE 和减轻相关不良结局的最佳策略。

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