Bellmunt-Montoya Sergi, Riera Claudia, Gil Daniel, Rodríguez Manuela, García-Reyes Marvin, Martínez-Carnovale Lucía, Marrero Carlos, Gil Miquel, Ruiz-Rodríguez Juan Carlos, Ferrer Ricard, de Nadal Miriam, Monreal Manel, Llagostera Secundino
Angiology and Vascular Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
Angiology and Vascular Surgery Department, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
Eur J Vasc Endovasc Surg. 2021 Apr;61(4):628-634. doi: 10.1016/j.ejvs.2020.12.015. Epub 2020 Dec 23.
The coronavirus disease of 2019 (COVID-19) due to SARS-CoV-2 infection has been found to cause an increased risk of venous thrombo-embolism (VTE). The aims of the study were to determine the frequency of VTE in critically ill patients with COVID-19 and its correlation with D dimer levels and pharmacological prophylaxis.
This was a cohort study of critically ill patients due to COVID-19. All patients admitted to the intensive care unit on the same day of April 2020 were selected, regardless of length of stay, and a single bilateral venous duplex ultrasound in the lower extremities was performed up to 72 hours later. Pulmonary embolism (PE) was diagnosed by computed tomography angiography. Asymptomatic and symptomatic VTE were registered, including pre-screening in hospital VTE. Characteristics of patients, blood test results, doses of thromboprophylaxis received, VTE events, and mortality after seven day follow up were recorded.
A total of 230 critically ill patients were studied. The median intensive care unit stay of these patients was 12 days (interquartile range [IQR] 5 - 19 days). After seven days follow up, the frequency of patients with VTE, both symptomatic and asymptomatic, was 26.5% (95% confidence interval [CI] 21% - 32%) (69 events in 61 patients): 45 with DVT and 16 with PE (eight of them with concomitant DVT). The cumulative frequency of symptomatic VTE was 8.3% (95% CI 4.7% - 11.8%). D dimer values ≥ 1 500 ng/mL were diagnostic of VTE, with a sensitivity of 80% and a specificity of 42%. During follow up after screening, six patients developed new VTE. Three of them developed a recurrence after a DVT diagnosed at screening, despite receiving therapeutic doses of heparin. Mortality rates at seven day follow up were the same for those with (6.6%) and without (5.3%) VTE.
Patients with severe COVID-19 infection are at high risk of VTE, and further new symptomatic VTE events and recurrence can occur despite anticoagulation. The prophylactic anticoagulant dose may need to be increased in patients with a low risk of bleeding.
已发现由严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染引起的2019冠状病毒病（COVID-19）会导致静脉血栓栓塞（VTE）风险增加。本研究的目的是确定COVID-19重症患者中VTE的发生率及其与D-二聚体水平和药物预防的相关性。
这是一项针对COVID-19重症患者的队列研究。选取了2020年4月同一天入住重症监护病房的所有患者，无论住院时间长短，并在72小时内对其进行了一次双侧下肢静脉双功超声检查。通过计算机断层血管造影诊断肺栓塞（PE）。记录了无症状和有症状的VTE，包括住院前VTE筛查。记录患者的特征、血液检查结果、接受的血栓预防剂量、VTE事件以及7天随访后的死亡率。
共研究了230例重症患者。这些患者在重症监护病房的中位住院时间为12天（四分位间距[IQR]5 - 19天）。随访7天后，有症状和无症状的VTE患者发生率为26.5%（95%置信区间[CI]21% - 32%）（61例患者发生69次事件）：45例发生深静脉血栓形成（DVT），16例发生PE（其中8例同时伴有DVT）。有症状VTE的累积发生率为8.3%（95%CI 4.7% - 11.8%）。D-二聚体值≥1500 ng/mL可诊断VTE，敏感性为80%，特异性为42%。在筛查后的随访期间，6例患者出现新的VTE。其中3例在筛查时诊断为DVT后复发，尽管接受了治疗剂量的肝素。有VTE患者和无VTE患者7天随访时的死亡率相同（分别为6.6%和5.3%）。
重症COVID-19感染患者发生VTE的风险很高，尽管进行了抗凝治疗，仍可能发生新的有症状VTE事件和复发。对于出血风险较低的患者，可能需要增加预防性抗凝剂的剂量。
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