Khanna Ajay Kumar, Khanna Divya
Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh India.
Department of Preventive Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Tata Memorial Cancer Centre, Varanasi, Uttar Pradesh India.
Indian J Surg. 2023 Feb;85(Suppl 1):133-140. doi: 10.1007/s12262-022-03423-2. Epub 2022 May 4.
The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared as pandemic by World Health Organization (WHO) in March 2020. The outbreak has caused 5,232,562 deaths worldwide until December 3rd, 2021. Though primarily affecting the respiratory system, involvement of other organ systems have been reported in severe disease. Venous thromboembolism (VTE) has been recognized as an important complication. Previous studies have reported the prevalence of VTE in intensive care unit (ICU) patients between 7 and 85% and in non-ICU patients between 0 and 19%. COVID-19 patients that are at high risk for VTE are also at increased risk for bleeding. In such cases, anticoagulation may potentially be harmful. Thereby, it is important to understand the risk factors for VTE predisposition in the COVID-19 patients, timing of VTE, and the rate of occurrence of VTE in hospitalized patients post-discharge. Comparison of the rate of occurrence of VTE in COVID-19 patients with the non-COVID-19 patients with similar disease severity is required to truly interpret the reportedly high rates of VTE in COVID-19 patients. Several pathophysiological mechanisms have been reported for the development of VTE in COVID-19. Autopsy-based studies have contributed to the existing knowledge. d-dimer, presently, seems to be the most suitable investigation for risk-identification of VTE supported by Doppler studies and overall clinical context. Further, prospective studies and clinical trials are essentially required to fill the gaps in evidence for occurrence, risk prediction and management of VTE in COVID-19 patients.
2019年冠状病毒病（COVID-19）由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起，2020年3月被世界卫生组织（WHO）宣布为大流行病。截至2021年12月3日，该疫情已在全球造成5232562人死亡。尽管主要影响呼吸系统，但在重症病例中也有其他器官系统受累的报道。静脉血栓栓塞（VTE）已被公认为一种重要的并发症。先前的研究报告称，重症监护病房（ICU）患者中VTE的患病率在7%至85%之间，非ICU患者中VTE的患病率在0%至19%之间。VTE高风险的COVID-19患者出血风险也增加。在这种情况下，抗凝可能有潜在危害。因此，了解COVID-19患者VTE易感性的风险因素、VTE发生时间以及出院后住院患者VTE的发生率很重要。需要将COVID-19患者与疾病严重程度相似的非COVID-19患者的VTE发生率进行比较，才能真正解读COVID-19患者中据报道较高的VTE发生率。已有几种关于COVID-19中VTE发生的病理生理机制的报道。基于尸检的研究为现有知识做出了贡献。目前，d-二聚体似乎是最适合用于VTE风险识别的检查，有多普勒研究和整体临床情况作为支持。此外，本质上需要前瞻性研究和临床试验来填补COVID-19患者VTE发生、风险预测和管理方面的证据空白。
