Al Harbi Shmeylan, Kensara Raed, Aljuhani Ohoud, Korayem Ghazwa B, Altebainawi Ali F, Al Harthi Abdullah, Vishwakarma Ramesh, Alenazi Alaa M, Almutairi Abdulmajed, Alshaya Omar, Alraddadi Sultan, Al Sulaiman Tareq, Aldakkan Latifah, Mahboob Reem, Alaamer Kholoud, Alissa Abdulrahman, Hafiz Awatif, Aldhayyan Nada, Althewaibi Sara, Alenezi Farhan, Alkhotani Nadeen Y, Alghamdi Sara A, Alenazi Abeer A, Al Sulaiman Khalid
Pharmaceutical Care Department, 48168King Abdulaziz Medical City, Riyadh, Saudi Arabia.
College of Pharmacy, 48149King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Clin Appl Thromb Hemost. 2022 Jan-Dec;28:10760296221103864. doi: 10.1177/10760296221103864.
Coagulation abnormalities are one of the most important complications of severe COVID-19, which might lead to venous thromboembolism (VTE). Hypercoagulability with hyperfibrinogenemia causes large vessel thrombosis and major thromboembolic sequelae. Statins are potentially a potent adjuvant therapy in COVID-19 infection due to their pleiotropic effect. This study aims to evaluate the effectiveness of statins in reducing the risk of thrombosis among hospitalized critically ill patients with COVID-19.
A multicenter, retrospective cohort study of all critically ill adult patients with confirmed COVID-19 admitted to Intensive Care Units (ICUs) between March 1, 2020, and March 31, 2021. Eligible patients were categorized based on their usage of statins throughout their ICU stay and were matched with a propensity score. The primary endpoint was the odds of all cases of thrombosis; other outcomes were considered secondary.
A total of 1039 patients were eligible; following propensity score matching, 396 patients were included (1:1 ratio). The odds of all thrombosis cases and VTE events did not differ significantly between the two groups (OR 0.84 (95% CI 0.43, 1.66), = 0.62 and OR 1.13 (95% CI 0.43, 2.98), = 0.81, respectively. On multivariable Cox proportional hazards regression analysis, patients who received statin therapy had lower 30-day (HR 0.72 (95 % CI 0.54, 0.97), = 0.03) and in-hospital mortality (HR 0.67 (95 % CI 0.51, 0.89), P = 0.007). Other secondary outcomes were not statistically significant between the two groups except for D-dimer levels (peak) during ICU stay.
The use of statin therapy during ICU stay was not associated with thrombosis reduction in critically ill patients with COVID-19; however, it has been associated with survival benefits.
凝血异常是重症新型冠状病毒肺炎（COVID-19）最重要的并发症之一，可能导致静脉血栓栓塞（VTE）。高凝状态伴高纤维蛋白原血症会引发大血管血栓形成及主要血栓栓塞后遗症。他汀类药物因其多效性，可能是COVID-19感染的一种有效辅助治疗药物。本研究旨在评估他汀类药物在降低COVID-19住院重症患者血栓形成风险方面的有效性。
对2020年3月1日至2021年3月31日期间入住重症监护病房（ICU）的所有确诊COVID-19的成年重症患者进行一项多中心回顾性队列研究。符合条件的患者根据其在ICU住院期间他汀类药物的使用情况进行分类，并进行倾向评分匹配。主要终点是所有血栓形成病例的比值比；其他结局视为次要结局。
共有1039例患者符合条件；经过倾向评分匹配后，纳入396例患者（1:1比例）。两组之间所有血栓形成病例和VTE事件的比值比无显著差异（分别为OR 0.84（95%CI 0.43，1.66），P = 0.62和OR 1.13（95%CI 0.43，2.98），P = 0.81）。在多变量Cox比例风险回归分析中，接受他汀类药物治疗的患者30天死亡率较低（HR 0.72（95%CI 0.54，0.97），P = 0.03），住院死亡率也较低（HR 0.67（95%CI 0.51，0.89），P = 0.007）。除ICU住院期间D-二聚体水平（峰值）外，两组之间的其他次要结局无统计学显著差异。
在COVID-19重症患者的ICU住院期间使用他汀类药物治疗与降低血栓形成无关；然而，它与生存获益相关。
