Institute of Health Systems Science - Feinstein Institutes for Medical Research and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Northwell Health at Lenox Hill Hospital, New York, NY, USA.
Expert Rev Hematol. 2022 Jul;15(7):597-605. doi: 10.1080/17474086.2022.2098104. Epub 2022 Jul 12.
Hospitalized COVID-19 patients, particularly those with high-risk features, are at risk for venous and arterial thromboembolic events for approximately 30 days or more after hospital discharge. Extended post-hospital discharge thromboprophylaxis has potential to reduce this risk.
Recent cohort, registry, and randomized trial data on the topic of extended post-discharge thromboprophylaxis in COVID-19 inpatients are reviewed, and key patient subgroups at high thrombotic risk are highlighted, with antithrombotic guidelines on the topic discussed.
COVID-19 inpatients with cardiovascular risk factors, advanced age, intensive care unit stay, or an IMPROVE VTE score of 4 or more or a score of 2 or 3 plus elevated D-dimers (> twice the upper limit of normal) or an IMPROVE-DD VTE score of ≥4 are at high thrombotic risk in the post-discharge period. These high-risk patient subgroups benefit from extended post-discharge thromboprophylaxis, specifically with rivaroxaban 10 mg daily for 35 days. Recent NIH and ISTH guidelines recommend or suggest this approach. Results from other clinical trials are pending.
COVID-19 住院患者，尤其是具有高危特征的患者，在出院后约 30 天或更长时间内存在静脉和动脉血栓栓塞事件的风险。延长出院后预防性抗凝治疗有可能降低这种风险。
对 COVID-19 住院患者延长出院后预防性抗凝治疗的最新队列研究、登记研究和随机临床试验数据进行了回顾，并强调了高血栓风险的关键患者亚组，同时讨论了该主题的抗血栓形成指南。
COVID-19 住院患者伴有心血管危险因素、高龄、入住重症监护病房或 IMPROVE VTE 评分≥4 分，或评分 2 分或 3 分加 D-二聚体升高（>正常值上限的两倍）或 IMPROVE-DD VTE 评分≥4 分，在出院后具有高血栓风险。这些高风险患者亚组从延长出院后预防性抗凝治疗中获益，特别是每日服用利伐沙班 10mg，共 35 天。最近 NIH 和 ISTH 指南推荐或建议采用这种方法。其他临床试验的结果仍在等待中。
