Zhonghua Jie He He Hu Xi Za Zhi. 2023 Apr 12;46(4):336-351. doi: 10.3760/cma.j.cn112147-20230206-00053.
Inpatients infected with SARS-CoV-2 are prone to various complications during clinical treatment, especially venous thromboembolism (VTE), which significantly increases the risk of unexpected death. In recent years, a series of authoritative guidelines and high-quality evidence-based medicine research evidence have been published internationally. This working group has recently formulated the Guidelines for Thrombosis Prevention and Anticoagulant Management of Hospitalized Patients with Novel Coronavirus Infection with multidisciplinary experts in the fields of VTE prevention, critical care and evidence-based medicine from international and domestic experts. Based on this, the working group elaborated on 13 clinical issues in urgent need of attention and solution in current clinical practice on the basis of the guidelines and defined standardized operational paths, including VTE risk and bleeding risk assessment in hospitalized patients with COVID-19, VTE prevention and anticoagulant management of hospitalized COVID-19 patients with different severity and special patient populations complicated with pregnancy, malignant tumors, underlying diseases or organ insufficiency, usage of antiviral and anti-inflammatory drugs or thrombocytopenia, in addition to VTE prevention and anticoagulant management of discharged COVID-19 patients, anticoagulant management of COVID-19 patients complicated with VTE during hospitalization, anticoagulant management in patients undergoing VTE therapy with COVID-19, risk factors of bleeding in hospitalized patients with COVID-19, clinical classification and corresponding management. In particular, by referring to the latest international guidelines and research evidence, this paper provides clear implementation recommendations on how to accurately determine the standard preventive dose anticoagulation and therapeutic dose anticoagulation for hospitalized patients with COVID-19. This paper is expected to provide standardized operational procedures and implementation norms for healthcare workers to managing thrombus prevention and anticoagulation in hospitalized patients with COVID-19.
感染新型冠状病毒2的住院患者在临床治疗期间容易出现各种并发症，尤其是静脉血栓栓塞（VTE），这显著增加了意外死亡的风险。近年来，国际上发表了一系列权威指南和高质量的循证医学研究证据。该工作组最近与国际和国内VTE预防、重症监护和循证医学领域的多学科专家共同制定了《新型冠状病毒感染住院患者血栓预防和抗凝管理指南》。在此基础上，工作组在指南的基础上阐述了当前临床实践中急需关注和解决的13个临床问题，并确定了标准化的操作路径，包括COVID-19住院患者的VTE风险和出血风险评估、不同严重程度以及合并妊娠、恶性肿瘤、基础疾病或器官功能不全等特殊患者群体的COVID-19住院患者的VTE预防和抗凝管理、抗病毒和抗炎药物的使用或血小板减少情况，此外还包括出院COVID-19患者的VTE预防和抗凝管理、住院期间合并VTE的COVID-19患者的抗凝管理、接受VTE治疗的COVID-19患者的抗凝管理、COVID-19住院患者出血的危险因素、临床分类及相应管理。特别是，通过参考最新的国际指南和研究证据，本文就如何准确确定COVID-19住院患者的标准预防性抗凝剂量和治疗性抗凝剂量提供了明确的实施建议。本文有望为医护人员管理COVID-19住院患者的血栓预防和抗凝提供标准化的操作程序和实施规范。
