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COVID-19 住院和非住院患者的血栓栓塞风险:全国队列的自身对照病例系列分析。

Thromboembolic Risk in Hospitalized and Nonhospitalized COVID-19 Patients: A Self-Controlled Case Series Analysis of a Nationwide Cohort.

机构信息

Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK.

School of Pharmacy, University College London, London, England, UK; Centre for Safe Medication Practice and Research, Department of Pharmacy and Pharmacology, University of Hong Kong, Hong Kong, China.

出版信息

Mayo Clin Proc. 2021 Oct;96(10):2587-2597. doi: 10.1016/j.mayocp.2021.07.002. Epub 2021 Jul 16.


DOI:10.1016/j.mayocp.2021.07.002
PMID:34607634
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8282478/
Abstract

OBJECTIVE: To assess the associations between coronavirus disease 2019 (COVID-19) infection and thromboembolism including myocardial infarction (MI), ischemic stroke, deep vein thrombosis (DVT), and pulmonary embolism (PE). PATIENTS AND METHODS: A self-controlled case-series study was conducted covering the whole of Scotland's general population. The study population comprised individuals with confirmed (positive test) COVID-19 and at least one thromboembolic event between March 2018 and October 2020. Their incidence rates during the risk interval (5 days before to 56 days after the positive test) and the control interval (the remaining periods) were compared intrapersonally. RESULTS: Across Scotland, 1449 individuals tested positive for COVID-19 and experienced a thromboembolic event. The risk of thromboembolism was significantly elevated over the whole risk period but highest in the 7 days following the positive test (incidence rate ratio, 12.01; 95% CI, 9.91 to 14.56) in all included individuals. The association was also present in individuals not originally hospitalized for COVID-19 (incidence rate ratio, 4.07; 95% CI, 2.83 to 5.85). Risk of MI, stroke, PE, and DVT were all significantly higher in the week following a positive test. The risk of PE and DVT was particularly high and remained significantly elevated even 56 days following the test. CONCLUSION: Confirmed COVID-19 infection was associated with early elevations in risk with MI, ischemic stroke, and substantially stronger and prolonged elevations with DVT and PE both in hospital and community settings. Clinicians should consider thromboembolism, especially PE, among people with COVID-19 in the community.

摘要

目的:评估 2019 年冠状病毒病(COVID-19)感染与血栓栓塞事件(包括心肌梗死[MI]、缺血性卒 中、深静脉血栓形成[DVT]和肺栓塞[PE])之间的关联。

患者和方法:本研究采用自身对照病例系列研究设计,覆盖了苏格兰全体人群。研究人群包括 2018 年 3 月至 2020 年 10 月期间确诊(阳性检测)COVID-19 且至少发生一次血栓栓塞事件的个体。个体在风险间隔期(阳性检测前 5 天至阳性检测后 56 天)和对照间隔期(其余时期)内的发生率进行个体内比较。

结果:在苏格兰,有 1449 名个体 COVID-19 检测呈阳性并发生血栓栓塞事件。在整个风险期内,血栓栓塞的风险显著升高,但在阳性检测后 7 天内风险最高(发生率比,12.01;95%CI,9.91 至 14.56),所有纳入个体均如此。在最初未因 COVID-19 住院的个体中也存在这种关联(发生率比,4.07;95%CI,2.83 至 5.85)。阳性检测后一周内,MI、卒中和 PE 的风险显著升高。PE 和 DVT 的风险特别高,甚至在检测后 56 天仍显著升高。

结论:确诊 COVID-19 感染与 MI、缺血性卒中和早期风险升高相关,在住院和社区环境中,DVT 和 PE 的风险显著升高且持续时间延长。临床医生应考虑社区中 COVID-19 患者存在血栓栓塞,尤其是 PE 的可能性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7e8/8282478/f337c14735dc/gr2_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7e8/8282478/3021c4f4d5cb/gr1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7e8/8282478/f337c14735dc/gr2_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7e8/8282478/3021c4f4d5cb/gr1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b7e8/8282478/f337c14735dc/gr2_lrg.jpg

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[5]
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[6]
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本文引用的文献

[1]
Venous Thromboembolism and Major Bleeding in Patients With Coronavirus Disease 2019 (COVID-19): A Nationwide, Population-Based Cohort Study.

Clin Infect Dis. 2021-12-16

[2]
Pulmonary Embolism and Deep Vein Thrombosis in COVID-19: A Systematic Review and Meta-Analysis.

Radiology. 2021-2

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Collider bias undermines our understanding of COVID-19 disease risk and severity.

Nat Commun. 2020-11-12

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Int J Stroke. 2021-2

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Associations between a smoke-free homes intervention and childhood admissions to hospital in Scotland: an interrupted time-series analysis of whole-population data.

Lancet Public Health. 2020-9

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Venous thromboembolism in patients with COVID-19: Systematic review and meta-analysis.

Thromb Res. 2020-8-12

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Stroke. 2020-7-31

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Eur Heart J. 2020-7-1

[9]
Neurological associations of COVID-19.

Lancet Neurol. 2020-7-2

[10]
COVID-19 Is an Independent Risk Factor for Acute Ischemic Stroke.

AJNR Am J Neuroradiol. 2020-6-25

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