COVID-19 患者肺栓塞的多中心队列的长期随访：抗凝管理和结局。
Long term follow-up of a multicentre cohort of COVID-19 patients with pulmonary embolism: Anticoagulation management and outcomes.
机构信息
Medical Department Altovicentino Hospital, Santorso, Vicenza, Italy.
Medical Department Altovicentino Hospital, Santorso, Vicenza, Italy.
出版信息
Thromb Res. 2023 Sep;229:73-76. doi: 10.1016/j.thromres.2023.06.019. Epub 2023 Jun 23.
BACKGROUND AND AIMS
Pulmonary embolism (PE) is a frequent complication in COVID19 hospitalized patients. Inflammatory storm and endothelial dysfunction due to the virus seem to be the two major risk factors for PE. Consequently, PE related to COVID19 could be consider as triggered by a transient inflammatory acute phase and treated for no longer than 3 months. However, few data are available on management of anticoagulation and risk of venous thromboembolic (VTE) recurrences in these patients and guidelines are still undefined. Aim of the present study is to evaluate the long-term follow-up of a cohort of covid-19 patients with PE.
METHODS
We conducted a retrospective multicenter study in four Italian hospitals between March 1st, 2020, and May 31st, 2021 in patients who experienced a PE during hospitalization for a COVID-19 pneumonia, excluding patients who died during hospitalization. Baseline characteristics were collected and patients were grouped according to duration of anticoagulant treatment (< 3 months or > 3 months). The primary outcome was incidence of VTE recurrence while secondary outcome was the composite of deaths, major hemorrhages and VTE recurrence during follow-up.
RESULTS
106 patients with PE were discharged, of these 95 (89.6 %) had follow up longer than 3 months (seven patients were lost to follow up and four died within three months). The median follow-up was 13 months (IQR 1-19). Overall, 23 % of subjects (22/95) were treated for 3 months or less and 76.8 % (73/95) received anticoagulation for >3 months. Of patients in the short treatment group, 4.5 % died, compared with 5.5 % of those in the longer treatment group (p = NS); no difference was shown in risk of VTE recurrence (0 % vs 4.1 %, p = NS), major bleeding (4.5 % vs 4.1 %, p = NS) or in composite outcome (9.1 % vs 11 %, p = NS). No difference was found between the two treatment groups for composite outcome using the Kaplan-Meier analysis (Log Rank Test p = 0.387).
CONCLUSION
In our retrospective multi-center cohort, prolongation of duration of anticoagulation seems not to affect risk of VTE recurrences, deaths and bleeding after a PE related to COVID-19.
背景和目的
肺栓塞（PE）是 COVID-19 住院患者的常见并发症。由于病毒引起的炎症风暴和内皮功能障碍似乎是 PE 的两个主要危险因素。因此，与 COVID-19 相关的 PE 可被视为由短暂的炎症急性期触发，并治疗时间不超过 3 个月。然而，关于这些患者抗凝治疗和静脉血栓栓塞（VTE）复发风险的管理数据很少，指南仍未明确。本研究的目的是评估一组 COVID-19 合并 PE 患者的长期随访结果。
方法
我们在 2020 年 3 月 1 日至 2021 年 5 月 31 日期间在意大利的四家医院进行了一项回顾性多中心研究，纳入了因 COVID-19 肺炎住院期间发生 PE 的患者，但不包括住院期间死亡的患者。收集了基线特征，并根据抗凝治疗时间（<3 个月或>3 个月）将患者分为两组。主要结局是 VTE 复发的发生率，次要结局是随访期间死亡、大出血和 VTE 复发的复合结局。
结果
106 例 PE 患者出院，其中 95 例（89.6%）的随访时间超过 3 个月（7 例失访，4 例在 3 个月内死亡）。中位随访时间为 13 个月（IQR 1-19）。总体而言，23%的患者（22/95）接受了 3 个月或更短时间的治疗，76.8%（73/95）接受了>3 个月的抗凝治疗。在短疗程组中，4.5%的患者死亡，而长疗程组中这一比例为 5.5%（p=NS）；VTE 复发风险（0%比 4.1%，p=NS）、大出血（4.5%比 4.1%，p=NS）或复合结局（9.1%比 11%，p=NS）无差异。使用 Kaplan-Meier 分析（Log Rank 检验 p=0.387），两组间复合结局无差异。
结论
在我们的回顾性多中心队列中，延长抗凝治疗时间似乎不会影响 COVID-19 相关 PE 后 VTE 复发、死亡和出血的风险。
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