Tamayo-Velasco Álvaro, Bombín-Canal Carolina, Cebeira María José, Sánchez-De Prada Laura, Miramontes-González José Pablo, Martín-Fernández Marta, Peñarrubia-Ponce María Jesús
Department of Haematology and Hemotherapy, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.
J Clin Med. 2022 Jun 15;11(12):3443. doi: 10.3390/jcm11123443.
The presence of a procoagulant state, COVID-19-related coagulopathy, and an increased rate of thrombotic events (TEs) is widely known about. However, descriptive studies are scarce. Here, we conducted a large retrospective study including 2894 hospitalized COVID-19 patients followed up during the first 18 months of the pandemic to completely characterize any TE. Major TEs showed a 3.45% incidence rate. TEs were associated with increased intubation/90-day mortality risk [OR = 1.71, 95% CI (1.12−2.61), p < 0.013]. Venous thrombotic events (VTEs) were more frequent than arterial thrombotic events (ATEs) (72% vs. 28%), associated with enhanced levels of D-dimer (cross-linked fibrin derivatives formed during thrombolysis), which were related to mortality but more useful for early detection of thrombosis. In this regard, D-dimer plasma levels above 2014 µg/mL at hospital admission identify TEs with 91% accuracy (AUC = 0.91, p < 0.001), rising to almost 95% (AUC = 0.94, p < 0.001) with a cut-off value of 2666 µg/mL in VTEs. Moreover, 41% of TEs occurred in patients receiving LMWH thromboprophylactic treatments in hospital or domiciliary therapies. SARS-CoV-2 infection along with a sedentary lifestyle derived from the confinement in 2020 could be more determinant than a procoagulant state in patients with risk factors for TEs. Furthermore, the normal results obtained from the thrombophilia study after the acute process are linked to this independent procoagulant state and to SARS-CoV-2-derived coagulopathy.
促凝状态、新冠病毒相关凝血病以及血栓形成事件（TEs）发生率增加的情况已广为人知。然而，描述性研究却很匮乏。在此，我们开展了一项大型回顾性研究，纳入了2894例住院的新冠病毒患者，这些患者在疫情的前18个月接受了随访，以全面描述任何血栓形成事件。主要血栓形成事件的发生率为3.45%。血栓形成事件与插管/90天死亡风险增加相关[比值比（OR）=1.71，95%置信区间（CI）（1.12−2.61），p<0.013]。静脉血栓形成事件（VTEs）比动脉血栓形成事件（ATEs）更常见（72%对28%），与D-二聚体（溶栓过程中形成的交联纤维蛋白衍生物）水平升高相关，D-二聚体与死亡率相关，但对血栓形成的早期检测更有用。在这方面，入院时血浆D-二聚体水平高于2014μg/mL可91%准确地识别血栓形成事件（曲线下面积[AUC]=0.91，p<0.001），对于静脉血栓形成事件，截断值为2666μg/mL时，准确率几乎达到95%（AUC=0.94，p<0.001）。此外，41%的血栓形成事件发生在接受低分子肝素血栓预防治疗的住院患者或居家治疗患者中。2020年因隔离导致的久坐不动的生活方式以及新冠病毒感染，对于有血栓形成事件风险因素的患者而言，可能比促凝状态更具决定性。此外，急性病程后血栓形成倾向研究获得的正常结果与这种独立的促凝状态以及新冠病毒所致凝血病有关。
