Al Raizah Abdulrahman, Al Askar Ahmed, Shaheen Naila, Aldosari Khalid, Alnahdi Mohamed, Luhanga Musumadi, Alshuaibi Turki, Bajhmoum Wail, Alharbi Khaled, Alsahari Ghaida, Algahtani Hadeel, Alrayes Eunice, Basendwah Abdulrahim, Abotaleb Alia, Almegren Mosaad
Division of Adult Hematology, Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, PO Box. 22490, 11426, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Saudi Society for Bone Marrow Transplant, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
Thromb J. 2021 Mar 3;19(1):13. doi: 10.1186/s12959-021-00265-y.
Several observational studies have reported the rate of venous and arterial thrombotic events in patients infected with COVID-19, with conflicting results. The aim of this study was to estimate the rate of thrombotic and bleeding events in hospitalized patients diagnosed with Coronavirus disease 2019 (COVID-19).
This was a multicenter study of 636 patients admitted between 20 March 2020 and 31 May 2020 with confirmed COVID-19 in four hospitals.
Over a median length of stay in the non-ICU group of 7 days and of 19 days in the ICU group, twelve patients were diagnosed with Venous thromboembolism (VTE) (1.8 %) (95 % CI, 1.1-3). The rate in the non-ICU group was 0.19 % (95 % CI, 0.04-0.84), and that in the ICU group was 10.3 % (95 % CI, 6.4-16.2). The overall rate of arterial event is 2.2 % (95 % CI, 1.4-3.3). The rates in the non-ICU and ICU groups were 0.94 % (95 % CI, 0.46-0.1.9) and 8.4 % (95 % CI, 5.0-14.0). The overall composite event rate was 2.9 % (95 % CI, 2.0-4.3). The composite event rates in the non-ICU and ICU groups were 0.94 % (95 % CI, 0.46-0.1.9) and 13.2 % (95 % CI, 8.7-19.5). The overall rate of bleeding is 1.7 % (95 % CI, 1.0-2.8). The bleeding rate in the non-ICU group was 0.19 % (95 % CI, 0.04-0.84), and that in the ICU group was 9.4 % (95 % CI, 5.7-15.1). The baseline D-dimer level was a significant risk factor for developing VTE (OR 1.31, 95 % CI, 1.08-1.57, p = 0.005) and composite events (OR 1.32, 95 % CI, 1.12-1.55, p = 0.0007).
In this study, we found that the VTE rates in hospitalized patients with COVID-19 might not be higher than expected. In contrast to the risk of VTE, we found a high rate of arterial and bleeding complications in patients admitted to the ICU. An elevated D-dimer level at baseline could predict thrombotic complications in COVID-19 patients and may assist in the identification of these patients. Given the high rate of bleeding, the current study suggests that the intensification of anticoagulation therapy in COVID-19 patients beyond the standard of care be pursued with caution and would best be evaluated in a randomized controlled study.
多项观察性研究报告了感染新型冠状病毒肺炎（COVID-19）患者的静脉和动脉血栓形成事件发生率，结果相互矛盾。本研究的目的是评估确诊为2019冠状病毒病（COVID-19）的住院患者的血栓形成和出血事件发生率。
这是一项对2020年3月20日至2020年5月31日期间在四家医院确诊为COVID-19的636例患者进行的多中心研究。
非重症监护病房（ICU）组的中位住院时间为7天，ICU组为19天，12例患者被诊断为静脉血栓栓塞症（VTE）（1.8%）（95%CI，1.1 - 3）。非ICU组的发生率为0.19%（95%CI，0.04 - 0.84），ICU组为10.3%（95%CI，6.4 - 16.2）。动脉事件的总体发生率为2.2%（95%CI，1.4 - 3.3）。非ICU组和ICU组的发生率分别为0.94%（95%CI，0.46 - 1.9）和8.4%（95%CI，5.0 - 14.0）。总体复合事件发生率为2.9%（95%CI，2.0 - 4.3）。非ICU组和ICU组的复合事件发生率分别为0.94%（95%CI，0.46 - 1.9）和13.2%（95%CI，8.7 - 19.5）。出血的总体发生率为1.7%（95%CI，1.0 - 2.8）。非ICU组的出血率为0.19%（95%CI，0.04 - 0.84），ICU组为9.4%（95%CI，5.7 - 15.1）。基线D-二聚体水平是发生VTE（OR 1.31，95%CI，1.08 - 1.57，p = 0.005）和复合事件（OR 1.32，95%CI，1.12 - 1.55，p = 0.0007）的显著危险因素。
在本研究中，我们发现COVID-19住院患者的VTE发生率可能并不高于预期。与VTE风险相反，我们发现入住ICU的患者动脉和出血并发症发生率较高。基线D-二聚体水平升高可预测COVID-19患者的血栓形成并发症，并可能有助于识别这些患者。鉴于出血发生率较高，本研究表明，对COVID-19患者强化抗凝治疗超出护理标准应谨慎进行，最好在随机对照研究中进行评估。
