COVID-19 Intermediate Care Unit, Careggi University Hospital, Florence, Italy.
Internal Medicine COVID-19 Unit, Ospedale Michele and Pietro Ferrero, Verduno, Cuneo, Italy.
PLoS One. 2023 Feb 2;18(2):e0280247. doi: 10.1371/journal.pone.0280247. eCollection 2023.
The aim of this study was to evaluate the incidence of deep vein thrombosis (DVT) of the lower limbs in patients hospitalized with COVID-19 pneumonia in a non-ICU setting according to the different waves of the SARS-CoV-2 pandemic.
Multicenter, prospective study of patients with COVID-19 pneumonia admitted to Internal Medicine units in Italy during the first (March-May 2020) and subsequent waves (November 2020 -April 2021) of the pandemic using a serial compression ultrasound (CUS) surveillance to detect DVT of the lower limbs.
Three-hundred-sixty-three consecutive patients were enrolled. The pooled incidence of DVT was 8%: 13.5% in the first wave, and 4.2% in the subsequent waves (p = 0.002). The proportion of patients with early (< 4 days) detection of DVT was higher in patients during the first wave with respect to those of subsequent waves (8.1% vs 1.9%; p = 0.004). Patients enrolled in different waves had similar clinical characteristics, and thrombotic risk profile. Less patients during the first wave received intermediate/high dose anticoagulation with respect to those of the subsequent waves (40.5% vs 54.5%; p = 0.005); there was a significant difference in anticoagulant regimen and initiation of thromboprophylaxis at home (8.1% vs 25.1%; p<0.001).
In acutely ill patients with COVID-19 pneumonia, the incidence of DVT of the lower limbs showed a 3-fold decrease during the first with respect to the subsequent waves of the pandemic. A significant increase in thromboprophylaxis initiation prior to hospitalization, and the increase of the intensity of anticoagulation during hospitalization, likely, played a relevant role to explain this observation.
本研究旨在评估非 ICU 环境中 COVID-19 肺炎住院患者下肢深静脉血栓形成（DVT）的发生率，并根据 SARS-CoV-2 大流行的不同波次进行分析。
本研究为多中心前瞻性研究，纳入意大利内科病房收治的 COVID-19 肺炎患者，于大流行的第一波（2020 年 3 月至 5 月）和后续波次（2020 年 11 月至 2021 年 4 月）期间使用连续压缩超声（CUS）监测来检测下肢 DVT。
共纳入 363 例连续患者。DVT 的总发生率为 8%：第一波为 13.5%，后续波次为 4.2%（p=0.002）。与后续波次相比，第一波次中早期（<4 天）检出 DVT 的患者比例更高（8.1%比 1.9%；p=0.004）。不同波次患者的临床特征和血栓形成风险特征相似。与后续波次相比，第一波次接受中/高剂量抗凝治疗的患者较少（40.5%比 54.5%；p=0.005）；抗凝方案和在家启动血栓预防措施方面存在显著差异（8.1%比 25.1%；p<0.001）。
在 COVID-19 肺炎急性发病的患者中，下肢 DVT 的发生率在大流行的第一波次较后续波次降低了 3 倍。在住院前更早启动血栓预防措施，以及住院期间抗凝强度增加，可能是导致这种观察结果的原因。
