Infectious Diseases Department, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 050474 Bucharest, Romania.
National Institute for Infectious Diseases "Prof. Dr. Matei Bals", 1 Calistrat Grozovici Street, 021105 Bucharest, Romania.
Viruses. 2023 Jul 12;15(7):1535. doi: 10.3390/v15071535.
The rate of thrombotic complications in COVID-19 patients is high and could be associated with the risk of unfavourable outcomes. Moreover, pulmonary thrombotic events can occur even in patients already on anticoagulant treatment. We present the case of a patient with severe COVID-19 pneumonia, without traditional risk factors for thrombosis, who developed massive pulmonary thrombosis (PT) despite therapeutic anticoagulation. The diagnosis was challenging, and the case raised concerns about the protective role of conventional anticoagulant treatment in COVID-19 pneumonia. Thus, we searched for literature reports on COVID-19 patients who developed PT despite being under anticoagulation therapy. We identified 13 cohort studies including 4058 patients of which 346 (8.5%) developed PT and nine case reports/series enrolling 14 patients. Four cohorts were further analysed, which reported data on risk factors for thrombosis, outcomes and biological characteristics. We found that there were no differences between patients with and without PT regarding the classical risk factors for thrombosis. PT occurred regardless of the anticoagulation regimen, and the risk factor identified was severe COVID-19 pneumonia and a stay in an intensive care unit (ICU). Pulmonary thrombotic events in patients with COVID-19 are rather inflammation-related than correlated with traditional thromboembolic risk factors, and the therapeutic approach must take into consideration this aspect.
COVID-19 患者的血栓并发症发生率较高，且可能与不良结局风险相关。此外，即使在接受抗凝治疗的患者中，也可能发生肺血栓栓塞事件。我们报告了一例重症 COVID-19 肺炎患者的病例，该患者无血栓形成的传统危险因素，但尽管接受了抗凝治疗，仍发生了大量肺血栓形成（PT）。该诊断极具挑战性，且该病例引发了对 COVID-19 肺炎常规抗凝治疗保护作用的担忧。因此，我们检索了 COVID-19 患者在接受抗凝治疗的情况下发生 PT 的文献报告。我们共纳入了 13 项队列研究，共纳入了 4058 例患者，其中 346 例（8.5%）发生了 PT，9 项病例报告/系列纳入了 14 例患者。我们进一步分析了 4 项队列研究，这些研究报告了血栓形成的危险因素、结局和生物学特征的数据。我们发现，发生 PT 和未发生 PT 的患者之间在血栓形成的经典危险因素方面无差异。PT 的发生与抗凝方案无关，且确定的危险因素为重症 COVID-19 肺炎和入住重症监护病房（ICU）。COVID-19 患者的肺血栓栓塞事件与其说是与传统血栓栓塞危险因素相关，不如说是与炎症相关，治疗方法必须考虑到这一方面。
