De Vita Antonio, De Matteis Giuseppe, d'Aiello Alessia, Ravenna Salvatore Emanuele, Liuzzo Giovanna, Lanza Gaetano Antonio, Massetti Massimo, Crea Filippo, Gasbarrini Antonio, Franceschi Francesco, Covino Marcello
Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
Department of Clinical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
J Clin Med. 2021 Oct 26;10(21):4973. doi: 10.3390/jcm10214973.
A prothrombotic state, attributable to excessive inflammation, cytokine storm, hypoxia, and immobilization, is a feature of SARS-CoV-2 infection. Up to 30% of patients with severe COVID-19 remain at high risk of thromboembolic events despite anticoagulant administration, with adverse impact on in-hospital prognosis.
We retrospectively studied 4742 patients with acute infectious respiratory disease (AIRD); 2579 were diagnosed to have COVID-19 and treated with heparin, whereas 2163 had other causes of AIRD. We compared the incidence and predictors of total, arterial, and venous thrombosis, both in the whole population and in a propensity score-matched subpopulation of 3036 patients (1518 in each group).
271 thrombotic events occurred in the whole population: 121 (4.7%) in the COVID-19 group and 150 (6.9%) in the no-COVID-19 group ( < 0.001). No differences in the incidence of total ( = 0.11), arterial ( = 0.26), and venous ( = 0.38) thrombosis were found between the two groups after adjustment for confounding clinical variables and in the propensity score-matched subpopulation. Likewise, there were no significant differences in bleeding rates between the two groups. Clinical predictors of arterial thrombosis included age ( = 0.006), diabetes mellitus ( = 0.034), peripheral artery disease ( < 0.001), and previous stroke ( < 0.001), whereas history of solid cancer ( < 0.001) and previous deep vein thrombosis ( = 0.007) were associated with higher incidence of venous thrombosis.
Hospitalized patients with COVID-19 treated with heparin do not seem to show significant differences in the cumulative incidence of thromboembolic events as well as in the incidence of arterial and venous thrombosis separately, compared with AIRD patients with different etiological diagnosis.
由于过度炎症、细胞因子风暴、缺氧和制动导致的血栓前状态是新型冠状病毒2（SARS-CoV-2）感染的一个特征。尽管给予了抗凝治疗，但高达30%的重症新型冠状病毒肺炎（COVID-19）患者仍处于血栓栓塞事件的高风险中，这对住院预后有不利影响。
我们回顾性研究了4742例急性感染性呼吸道疾病（AIRD）患者；其中2579例被诊断为COVID-19并接受肝素治疗，而2163例患有其他原因的AIRD。我们比较了全体人群以及倾向评分匹配的3036例患者亚组（每组1518例）中总体、动脉和静脉血栓形成的发生率及预测因素。
全体人群中发生了271例血栓事件：COVID-19组121例（4.7%），非COVID-19组150例（6.9%）（P<0.001）。在调整混杂临床变量后以及在倾向评分匹配的亚组中，两组之间总体（P = 0.11）、动脉（P = 0.26）和静脉（P = 0.38）血栓形成的发生率没有差异。同样，两组之间的出血率也没有显著差异。动脉血栓形成的临床预测因素包括年龄（P = 0.006）、糖尿病（P = 0.034）、外周动脉疾病（P<0.001）和既往中风（P<0.001），而实体癌病史（P<0.001）和既往深静脉血栓形成（P = 0.007）与静脉血栓形成的较高发生率相关。
与病因诊断不同的AIRD患者相比，接受肝素治疗的住院COVID-19患者在血栓栓塞事件累积发生率以及动脉和静脉血栓形成发生率方面似乎没有显著差异。
