Division of Vascular & Endovascular Surgery, Department of Surgery, 71020University of Hong Kong Medical Centre, Hong Kong, China.
Phlebology. 2022 Jun;37(5):326-337. doi: 10.1177/02683555211052170. Epub 2022 Apr 10.
COVID-19 associated VTE is a new disease entity with high morbidity and mortality. The aim of this paper is to review contemporary emerging literature on the incidence, pathophysiology, predictive prognostic indicators, and management consensus for Covid-19 related thrombotic complications, in particular DVT and PE.
A literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. All searches were done via PubMed. References of review articles were further screened according to the exclusion criteria.
In total, 154 records were identified and 20 duplicates were removed. A final 68 articles were included in the qualitative analysis. COVID-19 related thrombosis can affect multiple organs of the body, presenting in the form of arterial or venous thrombosis such as ischemic stroke, myocardial infarction, mesenteric ischemia, limb ischemia, DVT, or PE. DVT and PE has an overall incidence of 6-26%, and severely ill COVID-19 patients have even higher incidence of thromboembolism. On the other hand, incidence of arterial thromboembolism is much lower with incidence of 0.7%-3.7%. D-dimer is found to be an independent risk factor, and IMPROVE score, Caprini score, and Padua score have all been used as predictors. International guidelines suggest the use of low molecular weight heparin (LMWH) or fondaparinux for prophylaxis of VTE, and therapeutic dosage of weight adjusted LMWH for treatment if confirmed diagnosis.
Contemporary rapidly evolving evidence shows that COVID-19 associated thrombosis was a novel clinical entity, especially in severely ill COVID-19 patients. There are multiple society-driven guidelines only, but without any level 1 evidence for management regimen. The ideal dose for prophylaxis is not established and may vary depending on balance of bleeding and thrombosis risk. The risk of bleeding may be increased in patients in intensive care unit.
COVID-19 相关 VTE 是一种具有高发病率和死亡率的新疾病实体。本文旨在回顾有关 COVID-19 相关血栓并发症（特别是 DVT 和 PE）的发病率、病理生理学、预测预后指标和管理共识的当代新兴文献。
根据系统评价和荟萃分析的首选报告项目（PRISMA）声明进行文献回顾。所有搜索均通过 PubMed 进行。根据排除标准进一步筛选综述文章的参考文献。
共确定了 154 项记录，并去除了 20 项重复项。最终有 68 篇文章纳入定性分析。COVID-19 相关血栓可影响身体的多个器官，表现为动脉或静脉血栓形成，如缺血性脑卒中、心肌梗死、肠系膜缺血、肢体缺血、DVT 或 PE。DVT 和 PE 的总体发病率为 6-26%，重症 COVID-19 患者的血栓栓塞发生率更高。另一方面，动脉血栓栓塞的发病率要低得多，为 0.7%-3.7%。D-二聚体被发现是一个独立的危险因素，IMPROVE 评分、Caprini 评分和 Padua 评分都被用作预测指标。国际指南建议使用低分子肝素（LMWH）或磺达肝素钠进行 VTE 预防，如果确诊，使用治疗剂量的体重调整 LMWH。
当代迅速发展的证据表明，COVID-19 相关血栓形成是一种新的临床实体，尤其是在重症 COVID-19 患者中。虽然有多个由社会驱动的指南，但没有任何一级证据来管理方案。预防的理想剂量尚未确定，可能因出血和血栓形成风险的平衡而异。在重症监护病房的患者中，出血风险可能会增加。
