Lachant Daniel J, Lachant Neil A, Kouides Peter, Rappaport Stephen, Prasad Paritosh, White R James
Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, New York, USA.
Division of Hematology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA.
J Thromb Haemost. 2020 Oct;18(10):2640-2645. doi: 10.1111/jth.15032. Epub 2020 Aug 24.
Thrombotic disease complicates severe SARS-CoV-2 infection and is associated with increased morbidity and mortality. Various anticoagulation strategies have been evaluated in hospitalized patients to prevent complications. The impact of chronic anticoagulation before SARS-CoV-2 infection on the risk for subsequent thrombosis has not been systematically studied.
This was a retrospective single-center study. All patients with positive SARS-CoV-2 PCR testing from March 13, 2020, through May 6, 2020, at the University of Rochester Medical Center were identified. We included all patients receiving therapeutic anticoagulation for at least 1 month before COVID diagnosis. We documented the rate of thrombotic complications, type of anticoagulation, bleeding complications, and mortality.
A total of 107 SARS-CoV2-infected patients were chronically anticoagulated before SARS-CoV-2 testing with a median age of 78. Of those, 42 required hospital admission, with 17 requiring intensive care. No patients, inpatient or outpatient, were diagnosed with a new symptomatic thrombotic complication. Three patients had minor bleeding in the hospital. Thirteen (12%) patients died (69% male).
Our uncontrolled findings suggest that chronic anticoagulation at the time of infection may protect against thrombotic complications and decrease disease severity.
血栓性疾病使严重的新型冠状病毒2型（SARS-CoV-2）感染复杂化，并与发病率和死亡率增加相关。已对住院患者的各种抗凝策略进行了评估，以预防并发症。SARS-CoV-2感染前长期抗凝对后续血栓形成风险的影响尚未得到系统研究。
这是一项回顾性单中心研究。确定了2020年3月13日至2020年5月6日在罗切斯特大学医学中心所有SARS-CoV-2 PCR检测呈阳性的患者。我们纳入了在新冠诊断前接受至少1个月治疗性抗凝的所有患者。我们记录了血栓并发症发生率、抗凝类型、出血并发症和死亡率。
共有107例SARS-CoV-2感染患者在SARS-CoV-2检测前长期接受抗凝治疗，中位年龄为78岁。其中，42例需要住院，17例需要重症监护。没有患者（住院患者或门诊患者）被诊断出有新的症状性血栓并发症。3例患者在医院发生轻微出血。13例（12%）患者死亡（男性占69%）。
我们的非对照研究结果表明，感染时长期抗凝可能预防血栓并发症并降低疾病严重程度。
