Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
Japan Community Health Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan.
J Cardiol. 2022 Oct;80(4):285-291. doi: 10.1016/j.jjcc.2022.03.015. Epub 2022 Apr 5.
Data on thrombosis and current real-world management strategies for anticoagulation therapy are scarce but important for understanding current issues and unmet needs of an optimal management of patients with coronavirus disease 2019 (COVID-19).
The CLOT-COVID Study (thrombosis and antiCoaguLatiOn Therapy in patients with COVID-19 in Japan Study: UMIN000045800) was a retrospective, multicenter cohort study enrolling consecutive hospitalized patients with COVID-19 among 16 centers in Japan from April 2021 to September 2021, and we tried to capture the status of the patients in the fourth and fifth waves of the COVID-19 infections in Japan. We enrolled consecutive hospitalized patients who were diagnosed with COVID-19 and had a positive polymerase chain reaction test obtained from the hospital databases.
Among 2894 patients with COVID-19, 1245 (43%) received pharmacological thromboprophylaxis. The proportion of pharmacological thromboprophylaxis increased according to the severity of the COVID-19 in 9.8% with mild COVID-19, 61% with moderate COVID-19, and 97% with severe COVID-19. The types and doses of anticoagulants varied widely across the participating centers. During the hospitalization, 38 patients (1.3%) and 126 (4.4%) underwent ultrasound examinations for the lower extremities and contrast-enhanced computed tomography examinations, respectively, and 55 (1.9%) developed thrombosis, mostly venous thromboembolism (71%). The incidence of thrombosis increased according to the severity of the COVID-19 in 0.2% with mild COVID-19, 1.4% with moderate COVID-19, and 9.5% with severe COVID-19. Major bleeding occurred in 57 patients (2.0%) and 158 (5.5%) died, and 81% of them were due to respiratory failure from COVID-19 pneumonia.
In the present large-scale observational study, pharmacological thromboprophylaxis for hospitalized patients with COVID-19 was common especially in patients with severe COVID-19, and management strategies varied widely across the participating centers. The overall incidence of thrombosis was substantially low with an increased incidence according to the severity of the COVID-19.
关于血栓形成以及当前抗凝治疗的真实世界管理策略的数据十分匮乏，但对于了解 2019 冠状病毒病（COVID-19）患者的最佳管理的当前问题和未满足的需求至关重要。
CLOT-COVID 研究（血栓形成和抗凝血治疗 COVID-19 患者的研究：UMIN000045800）是一项回顾性、多中心队列研究，于 2021 年 4 月至 9 月在日本的 16 个中心连续纳入 COVID-19 住院患者，我们试图捕捉日本 COVID-19 感染的第四波和第五波期间患者的状况。我们连续纳入从医院数据库中获得 COVID-19 诊断且聚合酶链反应检测呈阳性的住院患者。
在 2894 例 COVID-19 患者中，有 1245 例（43%）接受了药物性血栓预防。根据 COVID-19 的严重程度，药物性血栓预防的比例有所增加，轻症 COVID-19 患者为 9.8%，中度 COVID-19 患者为 61%，重症 COVID-19 患者为 97%。抗凝剂的类型和剂量在参与中心之间差异很大。住院期间，分别有 38 例（1.3%）和 126 例（4.4%）患者接受了下肢超声检查和增强计算机断层扫描检查，55 例（1.9%）发生血栓形成，主要为静脉血栓栓塞症（71%）。根据 COVID-19 的严重程度，血栓形成的发生率有所增加，轻症 COVID-19 患者为 0.2%，中度 COVID-19 患者为 1.4%，重症 COVID-19 患者为 9.5%。57 例（2.0%）患者发生大出血，158 例（5.5%）患者死亡，其中 81%的患者因 COVID-19 肺炎导致呼吸衰竭而死亡。
在本大规模观察性研究中，COVID-19 住院患者的药物性血栓预防十分常见，尤其是重症 COVID-19 患者，且各参与中心的管理策略差异很大。总的血栓形成发生率较低，但根据 COVID-19 的严重程度呈上升趋势。
