Department of Hematology and Oncology, Lenox Hill Hospital, Northwell Health, New York, NY.
Department of Medicine, Lenox Hill Hospital, Northwell Health, New York, NY.
Am J Ther. 2022 Jul 1;29(4):e425-e436. doi: 10.1097/MJT.0000000000001515.
Coronavirus disease 2019 (COVID-19) is associated with elevated rates of major and fatal thrombotic events, postulated to be the result of a hypercoagulable state mediated through inflammatory and immunomodulatory mechanisms. Early observational studies showed that disease severity and elevated serum D-dimer levels can predict thrombotic risk in patients hospitalized with COVID-19 and reported an alarming phenomenon of breakthrough thrombosis despite standard-of-care prophylaxis, suggesting the need for enhanced thromboprophylactic strategies.
Data on anticoagulant agent selection, dosing, and duration for COVID-19 inpatients are now poised to inform updated professional society guidance. However, there remains limited high-quality data regarding postdischarge and especially ambulatory patients with COVID-19.
This review includes published, peer-reviewed, observational, and randomized controlled trial data and major professional society guidance informing thrombosis prevention and treatment in patients with COVID-19.
There remains great variability in the approach to anticoagulation in COVID-19. This article will review pathogenesis of COVID-related thrombosis and the evidence guiding thromboprophylaxis particularly in inpatients, with attention to the INSPIRATION, ACTION, RAPID, HEP-COVID, and multiplatform trials. Emerging thromboprophylaxis data from the postdischarge setting (particularly the recently published MICHELLE trial), and the outpatient setting, will be examined. Finally, thrombosis treatment considerations will briefly be reviewed.
Substantial high-quality data support practice changes to COVID-19 thromboprophylaxis. Risk stratification by setting, disease severity, and biomarkers such as D-dimer is critical in considering choice, dose, and duration of anticoagulants.
2019 年冠状病毒病（COVID-19）与主要和致命性血栓事件的发生率升高有关，据推测这是通过炎症和免疫调节机制介导的高凝状态的结果。早期观察性研究表明，疾病严重程度和血清 D-二聚体水平升高可预测 COVID-19 住院患者的血栓风险，并报告了尽管采用标准预防措施但仍发生突破性血栓的惊人现象，这表明需要增强抗血栓形成策略。
关于 COVID-19 住院患者的抗凝剂选择、剂量和持续时间的数据现在有望为更新专业协会指南提供信息。然而，关于 COVID-19 出院后患者，特别是门诊患者，仍缺乏高质量数据。
本综述包括已发表的、同行评议的、观察性和随机对照试验数据以及主要专业协会指南，这些指南为 COVID-19 患者的血栓预防和治疗提供信息。
COVID-19 中的抗凝方法仍存在很大差异。本文将回顾 COVID 相关血栓形成的发病机制以及特别针对住院患者的抗血栓形成预防的证据，重点关注 INSPIRATION、ACTION、RAPID、HEP-COVID 和多平台试验。将检查出院后（特别是最近发表的 MICHELLE 试验）和门诊环境中新兴的抗血栓形成预防数据。最后，将简要回顾血栓形成的治疗注意事项。
大量高质量数据支持 COVID-19 抗血栓形成预防的实践改变。通过设置、疾病严重程度和生物标志物（如 D-二聚体）进行风险分层，对于考虑抗凝剂的选择、剂量和持续时间至关重要。
