Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain.
Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Rev Clin Esp (Barc). 2023 May;223(5):255-261. doi: 10.1016/j.rceng.2023.03.003. Epub 2023 Mar 27.
Recent surgery is a well-known major transient risk factor for venous thromboembolism (VTE) due to the low risk of VTE recurrence after anticoagulation is discontinued. On the other hand, the risk of VTE recurrence among patients with COVID-19-associated VTE is unknown. This study aimed to compare the risk of VTE recurrence between patients with COVID-19- and surgery-associated VTE.
A prospective observational single-center study was performed including consecutive patients diagnosed with VTE in a tertiary hospital from January 2020 to May 2022 and followed up for at least 90 days. Baseline characteristics, clinical presentation, and outcomes were assessed. The incidence of VTE recurrence, bleeding, and death was compared between both groups.
A total of 344 patients were included in the study: 111 patients with surgery-associated VTE and 233 patients with COVID-19-associated VTE. Patients with COVID-19-associated VTE were more frequently men (65.7% vs 48.6%, p = 0.003). VTE recurrence was 3% among COVID-19 patients and 5.4% among surgical patients, with no significant differences (p = 0.364). The incidence rate of recurrent VTE was 1.25 per 1000 person-months in COVID-19 patients and 2.29 person-months in surgical patients, without significant differences (p = 0.29). In the multivariate analysis, COVID-19 was associated with higher mortality (HR 2.34; 95% CI 1.19-4.58), but not with a higher risk of recurrence (HR 0.52; 95% CI 0.17-1.61). No differences were found in recurrence in the multivariate competing risk analysis (SHR 0.82; 95% CI 0.40-2.05).
In patients with COVID-19 and surgery-associated VTE, the risk of recurrence was low, with no differences between both groups.
最近的手术是静脉血栓栓塞症（VTE）的一个已知的主要短暂风险因素，因为抗凝治疗停止后 VTE 复发的风险较低。另一方面，COVID-19 相关 VTE 患者的 VTE 复发风险尚不清楚。本研究旨在比较 COVID-19 相关 VTE 与手术相关 VTE 患者的 VTE 复发风险。
进行了一项前瞻性观察性单中心研究，纳入了 2020 年 1 月至 2022 年 5 月期间在一家三级医院诊断为 VTE 的连续患者，并至少随访 90 天。评估了基线特征、临床表现和结局。比较了两组之间 VTE 复发、出血和死亡的发生率。
共有 344 名患者入组研究：111 名患者为手术相关 VTE，233 名患者为 COVID-19 相关 VTE。COVID-19 相关 VTE 患者中男性更为常见（65.7%比 48.6%，p=0.003）。COVID-19 患者 VTE 复发率为 3%，手术患者为 5.4%，无显著差异（p=0.364）。COVID-19 患者复发性 VTE 的发生率为每 1000 人月 1.25 例，手术患者为每 1000 人月 2.29 例，无显著差异（p=0.29）。多变量分析显示，COVID-19 与更高的死亡率相关（HR 2.34；95%CI 1.19-4.58），但与更高的复发风险无关（HR 0.52；95%CI 0.17-1.61）。多变量竞争风险分析中未发现复发差异（SHR 0.82；95%CI 0.40-2.05）。
在 COVID-19 合并手术相关 VTE 的患者中，复发风险较低，两组之间无差异。
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