Vascular Medicine Unit, Cardiology Department, Versailles Hospital, Le Chesnay, France.
Cardiology Department, Versailles Hospital, Le Chesnay, France.
Vascular. 2024 Oct;32(5):1099-1106. doi: 10.1177/17085381231165083. Epub 2023 Apr 3.
The high prevalence of deep vein thrombosis (DVT) in patients admitted to intensive care unit (ICU) for COVID-19-related acute respiratory distress syndrome (ARDS) would justify systematic screening of these patients or higher therapeutic dose of heparin for thromboprophylaxis.
We performed a systematic echo-Doppler of the lower limb proximal veins during the first 48 h (visit 1) and from 7 to 9 days after visit 1 (visit 2) in consecutive patients admitted to the ICU of a university-affiliated tertiary hospital for severe proven COVID-19 during the second wave. All patients received intermediate-dose heparin (IDH). The primary objective was to determine DVT incidence on venous Doppler ultrasound. Secondary objectives were to determine whether the presence of DVT modifies the anticoagulation regimen, the incidence of major bleeding according to International Society on Thrombosis and Haemostasis (ISTH) criteria, and the mortality rate of patients with and without DVT.
We included 48 patients (30 [62.5%] men) with a median age of 63 years [IQR, 54-70]. The prevalence of proximal deep vein thrombosis was 4.2% (2/48). In these two patients, after DVT diagnosis, anticoagulation was changed from intermediate to curative dose. Two patients (4.2%) had a major bleeding complication according to ISTH criteria. Among the 48 patients, 9 (18.8%) died before hospital discharge. No DVT or pulmonary embolism was diagnosed in these deceased patients during their hospital stay.
In critically ill patients with COVID-19, management with IDH results in a low incidence of DVT. Although our study is not designed to demonstrate any difference in outcome, our results do not suggest any signal of harm when using intermediate-dose heparin (IDH) COVID-19 with a frequency of major bleeding complications less than 5%.
COVID-19 相关急性呼吸窘迫综合征（ARDS）入住重症监护病房（ICU）的患者深静脉血栓（DVT）的高发病率将证明对这些患者进行系统筛查或更高治疗剂量肝素进行血栓预防是合理的。
我们对第二波期间在大学附属三级医院因严重确诊 COVID-19 入住 ICU 的连续患者在入住 ICU 的前 48 小时内（第 1 次就诊[就诊 1]）和就诊 1 后 7-9 天（就诊 2）进行了下肢近端静脉的系统超声检查。所有患者均接受中等剂量肝素（IDH）治疗。主要目的是确定静脉多普勒超声检查的 DVT 发生率。次要目标是确定 DVT 的存在是否改变抗凝方案、根据国际血栓形成和止血学会（ISTH）标准发生的大出血发生率以及有和无 DVT 的患者的死亡率。
我们纳入了 48 名患者（30 名[62.5%]男性），中位年龄为 63 岁[IQR，54-70]。近端深静脉血栓形成的患病率为 4.2%（2/48）。在这两名患者中，诊断为 DVT 后，抗凝从中等剂量改为治疗剂量。根据 ISTH 标准，有 2 名患者（4.2%）发生大出血并发症。在 48 名患者中，有 9 名（18.8%）在出院前死亡。在这些住院期间，这些死亡患者均未诊断出 DVT 或肺栓塞。
在 COVID-19 危重症患者中，使用 IDH 管理导致 DVT 的发病率较低。尽管我们的研究设计不是为了证明结果存在差异，但我们的结果表明，在 COVID-19 中使用中等剂量肝素（IDH）时，其大出血并发症的频率小于 5%，不会产生任何危害信号。
