Department of Hospital Medicine, Ochsner Health, New Orleans, LA.
Department of Medicine, University of Washington, Seattle, WA.
Blood Adv. 2020 Nov 10;4(21):5373-5377. doi: 10.1182/bloodadvances.2020003083.
Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appear to be at increased risk for venous thromboembolism (VTE), especially if they become critically ill with COVID-19. Some centers have reported very high rates of thrombosis despite anticoagulant prophylaxis. The electronic health record (EHR) of a New Orleans-based health system was searched for all patients with polymerase chain reaction-confirmed SARS-CoV-2 infection who were either admitted to hospital or treated and discharged from an emergency department between 1 March 2020 and 1 May 2020. From this cohort, patients with confirmed VTE (either during or after their hospital encounter) were identified by administrative query of the EHR.: Between 1 March 2020 and 1 May 2020, 6153 patients with COVID-19 were identified; 2748 of these patients were admitted, while 3405 received care exclusively through the emergency department. In total, 637 patients required mechanical ventilation and 206 required renal replacement therapy. Within the hospitalized cohort, the overall mortality rate was 24.5% and VTE occurred in 86 patients (3.1%). In the 637 patients who required mechanical ventilation at some point during their hospital stay, 45 developed VTE (7.2%). After a median follow-up of 14.6 days, VTE had been diagnosed in 3 of the 2075 admitted who were discharged alive (0.14%). Among 6153 patients with COVID-19 who were hospitalized or treated in emergency departments, we did not find evidence of unusually high VTE risk. Pending further evidence from prospective, controlled trials, our findings support a traditional approach to primary VTE prevention in patients with COVID-19.
感染严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）的患者似乎有发生静脉血栓栓塞症（VTE）的风险增加，尤其是在因 COVID-19 而病重时。一些中心报告尽管采用抗凝预防措施，但血栓形成率仍很高。搜索了一家新奥尔良市医疗系统的电子健康记录（EHR），以寻找所有经聚合酶链反应确认的 SARS-CoV-2 感染患者，这些患者在 2020 年 3 月 1 日至 5 月 1 日期间因 COVID-19 住院或在急诊接受治疗并出院。从该队列中，通过对 EHR 的行政查询确定了有确诊 VTE（无论是在住院期间还是之后）的患者：在 2020 年 3 月 1 日至 5 月 1 日期间，共发现 6153 例 COVID-19 患者；其中 2748 例患者住院，3405 例仅通过急诊接受治疗。总共 637 例患者需要机械通气，206 例需要肾脏替代治疗。在住院患者队列中，总体死亡率为 24.5%，86 例患者发生 VTE（3.1%）。在住院期间有过机械通气的 637 例患者中，有 45 例发生 VTE（7.2%）。中位随访 14.6 天后，在 2075 例出院存活的住院患者中，有 3 例诊断出 VTE（0.14%）。在因 COVID-19 住院或在急诊治疗的 6153 例患者中，我们没有发现 VTE 风险异常高的证据。在有前瞻性、对照试验的进一步证据之前，我们的研究结果支持对 COVID-19 患者采用传统方法进行原发性 VTE 预防。
