COVID-19因增强的血凝块强度和纤维蛋白溶解停止对髋部骨折患者血栓形成风险的促凝作用。
The Procoagulant Effect of COVID-19 on the Thrombotic Risk of Patients with Hip Fractures Due to Enhanced Clot Strength and Fibrinolysis Shutdown.
作者信息
Tsantes Andreas G, Papadopoulos Dimitrios V, Trikoupis Ioannis G, Goumenos Stavros, Piovani Daniele, Tsante Konstantina A, Mavrogenis Andreas F, Vaiopoulos Aristeidis G, Koulouvaris Panagiotis, Nikolopoulos Georgios K, Papagelopoulos Panayiotis J, Bonovas Stefanos, Tsantes Argirios E
机构信息
Laboratory of Haematology and Blood Bank Unit, "Attiko" Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece.
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15237, USA.
出版信息
J Clin Med. 2021 Jul 30;10(15):3397. doi: 10.3390/jcm10153397.
INTRODUCTION
Coronavirus disease 2019 (COVID-19) in patients with hip fractures is associated with increased incidence of venous thromboembolism (VTE). The purpose of this study was to evaluate the hemostatic alterations of COVID-19 that are associated with a higher thrombotic risk using rotational thromboelastometry (ROTEM).
METHODS
A retrospective observational study was performed including 20 COVID-19 patients with hip fractures. To compare the coagulopathy of patients with mild COVID-19 and hip fractures with the coagulopathy associated with each of these two conditions separately, we used two previously recruited groups of patients; 198 hip fracture patients without COVID-19 and 21 COVID-19 patients without hip fractures. The demographics, clinical parameters, conventional coagulation parameters and ROTEM findings of the three groups were analyzed and compared.
RESULTS
COVID-19 hip fracture patients had higher amplitude of clot firmness at 10 min ( < 0.001), higher alpha angle ( < 0.001), higher lysis index at 60 min ( < 0.001), and shorter clot formation time ( < 0.001) than non-COVID-19 hip fracture patients, indicating increased clot strength and impaired fibrinolysis due to COVID-19. The value of lysis index at 60 min (99%) in COVID-19 patients with hip fractures was consistent with fibrinolysis shut down. Multivariable linear regression analysis further confirmed that COVID-19 resulted in increased amplitude of clot firmness at 10 min ( < 0.001), increased maximum clot firmness ( < 0.001), increased lysis index at 60 min ( < 0.001) and increased alpha angle ( < 0.001), but significantly shortened clot formation time ( < 0.001).
DISCUSSION
The higher thrombotic risk in COVID-19 patients with hip fractures is characterized by increased clot strength and fibrinolysis shutdown, as shown by ROTEM findings. Further prospective studies are warranted to evaluate the need for modification of thromboprophylaxis to balance the hemostatic derangements of COVID-19 patients with hip fractures.
引言
髋部骨折患者感染2019冠状病毒病（COVID-19）与静脉血栓栓塞症（VTE）发病率增加相关。本研究旨在使用旋转血栓弹力图（ROTEM）评估与较高血栓形成风险相关的COVID-19止血改变。
方法
进行了一项回顾性观察研究，纳入20例COVID-19髋部骨折患者。为了分别比较轻度COVID-19合并髋部骨折患者的凝血病与这两种疾病各自相关的凝血病，我们使用了之前招募的两组患者；198例无COVID-19的髋部骨折患者和21例无髋部骨折的COVID-19患者。分析并比较了三组患者的人口统计学、临床参数、传统凝血参数和ROTEM结果。
结果
与非COVID-19髋部骨折患者相比，COVID-19髋部骨折患者在10分钟时的血凝块硬度振幅更高（<0.001）、α角更高（<0.001）、60分钟时的溶解指数更高（<0.001）且凝血形成时间更短（<0.001），这表明COVID-19导致血凝块强度增加和纤维蛋白溶解受损。COVID-19髋部骨折患者60分钟时的溶解指数值（99%）与纤维蛋白溶解停止一致。多变量线性回归分析进一步证实，COVID-19导致10分钟时的血凝块硬度振幅增加（<0.001）、最大血凝块硬度增加（<0.001）、60分钟时的溶解指数增加（<0.001）以及α角增加（<0.001），但凝血形成时间显著缩短（<0.001）。
讨论
如ROTEM结果所示，COVID-19髋部骨折患者较高的血栓形成风险表现为血凝块强度增加和纤维蛋白溶解停止。有必要进一步开展前瞻性研究，以评估是否需要调整血栓预防措施，以平衡COVID-19髋部骨折患者的止血紊乱情况。
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