Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States.
Division of Hematology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Thromb Haemost. 2021 Jan;121(1):76-85. doi: 10.1055/s-0040-1721664. Epub 2020 Dec 30.
Coronavirus disease 2019 (COVID-19) increases thrombosis in hospitalized patients prompting adoption of different thromboprophylaxis strategies. Safety and efficacy of escalated-dose pharmacologic thromboprophylaxis are not established.
To determine the pooled incidence of thrombosis/bleeding in hospitalized patients with COVID-19 for standard-dose, intermediate-dose, therapeutic anticoagulation, and no pharmacologic thromboprophylaxis.
MEDLINE, EMBASE, and Cochrane CENTRAL were searched up to August 29, 2020 for studies reporting pharmacologic thromboprophylaxis and thrombosis or bleeding. Pooled event rates were calculated using a random-effects model.
Thirty-five observational studies were included. The pooled incidence rates of total venous thromboembolism ( = 4,685) were: no prophylaxis 41.9% (95% confidence interval [CI]: 28.1-57.2, = 76%), standard-dose prophylaxis 19.8% (95% CI: 13.2-28.6, = 95%), intermediate-dose prophylaxis 11.9% (95% CI: 4.3-28.6, = 91%), and therapeutic-dose anticoagulants 10.5% (95% CI: 4.2-23.8, = 82%, = 0.003). The pooled incidence rates of arterial thrombosis ( = 1,464) were: no prophylaxis 11.3% (95% CI: 5.2-23.0, = 0%), standard-dose prophylaxis 2.5% (95% CI: 1.4-4.3, = 45%), intermediate-dose prophylaxis 2.1% (95% CI: 0.5-7.7, = 45%), and therapeutic-dose anticoagulants 1.3% (95% CI: 0.2-8.8, = 0, = 0.009). The pooled bleeding event rates ( = 6,393) were nonsignificantly higher in therapeutic-dose anticoagulants compared with standard-dose prophylaxis, (6.3 vs. 1.7%, = 0.083).
Thrombosis rates were lower in hospitalized COVID-19 patients who received pharmacologic thromboprophylaxis. Thrombosis and bleeding rates for patients receiving intermediate-dose thromboprophylaxis or therapeutic anticoagulation were similar to those who received standard-dose pharmacologic thromboprophylaxis.
2019 年冠状病毒病（COVID-19）会增加住院患者的血栓形成，促使采用不同的血栓预防策略。强化剂量的药物性血栓预防的安全性和有效性尚未确定。
确定 COVID-19 住院患者接受标准剂量、中剂量、治疗性抗凝和无药物性血栓预防的血栓形成/出血的汇总发生率。
截至 2020 年 8 月 29 日，检索 MEDLINE、EMBASE 和 Cochrane CENTRAL 以获取报告药物性血栓预防和血栓形成或出血的研究。使用随机效应模型计算汇总事件发生率。
纳入了 35 项观察性研究。总静脉血栓栓塞（ = 4685）的汇总发生率分别为：无预防措施 41.9%（95%置信区间[CI]：28.1-57.2， = 76%）、标准剂量预防措施 19.8%（95% CI：13.2-28.6， = 95%）、中剂量预防措施 11.9%（95% CI：4.3-28.6， = 91%）和治疗剂量抗凝剂 10.5%（95% CI：4.2-23.8， = 82%， = 0.003）。动脉血栓形成（ = 1464）的汇总发生率分别为：无预防措施 11.3%（95% CI：5.2-23.0， = 0%）、标准剂量预防措施 2.5%（95% CI：1.4-4.3， = 45%）、中剂量预防措施 2.1%（95% CI：0.5-7.7， = 45%）和治疗剂量抗凝剂 1.3%（95% CI：0.2-8.8， = 0%， = 0.009）。与标准剂量预防措施相比，治疗剂量抗凝剂的出血事件发生率（ = 6393）显著更高，分别为 6.3%和 1.7%（ = 0.083）。
接受药物性血栓预防的 COVID-19 住院患者的血栓形成率较低。接受中剂量血栓预防或治疗性抗凝的患者的血栓形成和出血率与接受标准剂量药物性血栓预防的患者相似。
