Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañon, Madrid, Spain.
Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Eur J Haematol. 2021 May;106(5):716-723. doi: 10.1111/ejh.13603. Epub 2021 Mar 3.
COVID-19 predisposes patients to a higher risk of venous thromboembolism (VTE), although the extent of these implications is unclear and the risk of bleeding has been poorly evaluated. To date, no studies have reported long-term outcomes of patients with COVID-19 and VTE.
Prospective observational study to evaluate long-term (90 days or more) outcomes of patients diagnosed with VTE (PE, DVT of the extremities, or both) in the setting of COVID-19. The main outcome of the study was a compound of major bleeding and death.
The study comprised 100 patients (mean age 65 ± 13.9 years). At the time of VTE diagnosis, 66% patients were hospitalized, 34.8% of them in the ICU. Mean follow-up was 97.9 ± 23.3 days. During the study period, 24% patients died and median time to death was 12 (IQR: 2.25-20.75) days, 11% patients had major bleeding and median time to event was 12 (IQR: 5-16) days. The cause of death was PE in 5% and bleeding in 2% of patients. There were no VTE recurrences. The main study outcome occurred in 29% patients. Risk of death or major bleeding was independently associated with ICU admission (HR 12.2; 95% CI 3.0-48.3), thrombocytopenia (HR 4.5; 95% CI 1.2-16.5), and cancer (HR 21.6; 95% CI 1.8-259).
In patients with COVID-19 and VTE, mortality and major bleeding were high and almost a third of deaths were VTE-related. The majority of complications occurred in the first 30 days. ICU admission, thrombocytopenia, and cancer are risk factors for poor prognosis.
COVID-19 使患者有更高的静脉血栓栓塞 (VTE) 风险，尽管这些影响的程度尚不清楚，且出血风险评估不佳。迄今为止，尚无研究报告 COVID-19 合并 VTE 患者的长期结局。
前瞻性观察研究评估 COVID-19 背景下诊断为 VTE（PE、四肢 DVT 或两者兼有）患者的长期（90 天或以上）结局。研究的主要结局是大出血和死亡的复合事件。
该研究纳入了 100 例患者（平均年龄 65 ± 13.9 岁）。在 VTE 诊断时，66%的患者住院，其中 34.8%在 ICU。平均随访时间为 97.9 ± 23.3 天。在研究期间，24%的患者死亡，中位死亡时间为 12（IQR：2.25-20.75）天，11%的患者发生大出血，中位事件时间为 12（IQR：5-16）天。死亡原因分别为 PE（5%）和出血（2%）。无 VTE 复发。主要研究结局发生在 29%的患者中。死亡或大出血的风险与 ICU 入院（HR 12.2；95%CI 3.0-48.3）、血小板减少症（HR 4.5；95%CI 1.2-16.5）和癌症（HR 21.6；95%CI 1.8-259）独立相关。
在 COVID-19 合并 VTE 的患者中，死亡率和大出血发生率高，近三分之一的死亡与 VTE 相关。大多数并发症发生在最初的 30 天内。ICU 入院、血小板减少症和癌症是预后不良的危险因素。
