Department of Medicine, University of Arizona/Banner University Medical Center, Tucson, AZ.
Department of Oncology, Sanford Health /University of North Dakota School of Medicine and Health Sciences, Fargo, ND.
Am J Ther. 2020 Nov/Dec;27(6):e599-e610. doi: 10.1097/MJT.0000000000001295.
Venous thromboembolism (VTE) is increasingly reported in seriously ill patients with COVID-19 infection. Incidence of VTE has been reported before and results varied widely in study cohorts.
Incidence of major VTE (segmental pulmonary embolism and above and proximal deep vein thrombosis) which is a contributor to mortality and morbidity is not known. Also, data is unclear on the optimal anticoagulation regimen to prevent VTE.
Multiple databases including PubMed were searched until May 12, 2020, to include studies reporting VTE in hospitalized COVID-19 adult patients. MOOSE guidelines were followed in selection, and 11 studies were included. We conducted a systematic review and meta-analysis to quantitatively assess the VTE burden in hospitalized COVID-19 patients and potential benefits of therapeutic dosing of anticoagulation compared with prophylaxis dosing for VTE prevention.
Many societies and experts recommend routine prophylactic anticoagulation with heparin for VTE prevention in hospitalized COVID-19 patients. In this meta-analysis, the pooled rate of major VTE was 12.5% in hospitalized patients and 17.2% in intensive care unit patients. When therapeutic anticoagulation dosing was compared with prophylactic anticoagulation, the pooled odds ratio of VTE was 0.33 (95% confidence interval 0.14-0.75; P = 0.008, I = 0%) suggesting statistical significance with therapeutic dosing of anticoagulation for primary prevention of VTE in all hospitalized patients. However, this should be interpreted with caution as the bleeding events and safety profile could not be ascertained because of lack of adequate information. We recommend applying this finding to hospitalized COVID 19 patients only after carefully weighing individual bleeding risks and benefits.
Major VTE events, especially pulmonary embolism, seem to be high in COVID-19 patients admitted to the intensive care unit. Therapeutic anticoagulation dosing seems to significantly benefit the odds of preventing any VTE when compared with prophylactic dosing in all hospitalized patients.
静脉血栓栓塞症（VTE）在 COVID-19 感染的重症患者中越来越常见。VTE 的发病率之前已有报道，但在不同的研究队列中结果差异很大。
导致死亡率和发病率的主要 VTE（节段性肺栓塞及以上和近端深静脉血栓形成）的发病率尚不清楚。此外，关于预防 VTE 的最佳抗凝治疗方案的数据也不清楚。
直到 2020 年 5 月 12 日，我们在多个数据库（包括 PubMed）中进行了检索，以纳入报告住院 COVID-19 成年患者 VTE 的研究。我们遵循 MOOSE 指南进行选择，并纳入了 11 项研究。我们进行了系统评价和荟萃分析，以定量评估住院 COVID-19 患者的 VTE 负担以及与预防剂量相比，治疗剂量抗凝在预防 VTE 方面的潜在获益。
许多学会和专家建议对住院 COVID-19 患者常规进行肝素预防性抗凝以预防 VTE。在这项荟萃分析中，住院患者的主要 VTE 发生率为 12.5%，重症监护病房患者为 17.2%。与预防性抗凝相比，治疗性抗凝剂量的 VTE 合并比值比为 0.33（95%置信区间 0.14-0.75；P = 0.008，I = 0%），提示治疗性抗凝剂量在预防所有住院患者的 VTE 方面具有统计学意义。然而，由于缺乏足够的信息，无法确定出血事件和安全性概况，因此应谨慎解释这一结果。我们建议在仔细权衡个体出血风险和获益后，仅将这一发现应用于住院 COVID-19 患者。
入住重症监护病房的 COVID-19 患者中，VTE 事件，尤其是肺栓塞，似乎发生率较高。与预防性抗凝相比，治疗性抗凝剂量似乎显著降低了所有住院患者发生任何 VTE 的风险。
