Amani-Beni Reza, Kermani-Alghoraishi Mohammad, Darouei Bahar, Reid Christopher M
Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Egypt Heart J. 2023 Aug 18;75(1):72. doi: 10.1186/s43044-023-00400-2.
Coronavirus disease of 2019 (COVID-19) is associated with venous thromboembolism (VTE), not only during hospitalization but also after discharge, raising concerns about anticoagulant (AC) use for post-discharge COVID-19 patients. We aimed to systematically review the current literature on the possible benefits or risks regarding extended thromboprophylaxis.
We searched related databases from December 1, 2019, to October 6, 2022, including studies on the necessity, duration, and selection of the ideal AC regarding extended thromboprophylaxis for post-discharge COVID-19 patients. The screening of the selected databases led to 18 studies and 19 reviews and guidelines. Studies included 52,927 hospitalized COVID-19 patients, with 19.25% receiving extended thromboprophylaxis. VTE events ranging from 0 to 8.19% (median of 0.7%) occurred in a median follow-up of 49.5 days. All included studies and guidelines, except four studies, recommended post-discharge prophylaxis after an individual risk assessment indicating high thrombotic and low bleeding risk. Studies used risk assessment models (RAMs), clinical evaluation, and laboratory data to identify COVID-19 patients with a high risk of VTE. IMPROVE-DD was the most recommended RAM. Direct oral anticoagulants (DOACs) and low molecular weight heparins (LMWHs) were the most used AC classes.
Post-discharge prophylaxis for COVID-19 patients is recommended after an individual assessment. The IMPROVE-DD model can help predict VTE risk. After distinguishing patients who need post-discharge AC therapy, DOACs for 30-35 days and LMWHs for 40-45 days can be the drug of choice. Further studies, particularly the results of the ongoing randomized controlled trials (RCTs), are required. Also, to properly handle such patients, every physician should consider lifestyle modification in addition to pharmacological treatment for post-discharge VTE prophylaxis.
2019年冠状病毒病（COVID-19）与静脉血栓栓塞症（VTE）相关，不仅在住院期间，出院后也会出现，这引发了人们对出院后COVID-19患者使用抗凝剂（AC）的担忧。我们旨在系统回顾当前关于延长血栓预防的潜在益处或风险的文献。
我们检索了2019年12月1日至2022年10月6日的相关数据库，包括关于出院后COVID-19患者延长血栓预防的理想抗凝剂的必要性、持续时间和选择的研究。对所选数据库的筛选产生了18项研究以及19篇综述和指南。研究纳入了52927例住院COVID-19患者，其中19.25%接受了延长血栓预防。在中位随访49.5天期间，VTE事件发生率为0至8.19%（中位值为0.7%）。除四项研究外，所有纳入的研究和指南均建议在个体风险评估显示高血栓形成风险和低出血风险后进行出院后预防。研究使用风险评估模型（RAMs）、临床评估和实验室数据来识别具有高VTE风险的COVID-19患者。IMPROVE-DD是最常被推荐的RAM。直接口服抗凝剂（DOACs）和低分子量肝素（LMWHs）是最常用的抗凝剂类别。
建议对COVID-19患者进行个体评估后进行出院后预防。IMPROVE-DD模型有助于预测VTE风险。在区分出需要出院后抗凝治疗的患者后，DOACs使用30 - 35天和LMWHs使用40 - 45天可为首选药物。需要进一步的研究，特别是正在进行的随机对照试验（RCTs）的结果。此外，为妥善处理此类患者，每位医生在进行出院后VTE预防的药物治疗时，还应考虑生活方式的改变。
