Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Sforza 35, Milan, Italy.
Laboratory of Geriatric Epidemiology, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
Intern Emerg Med. 2024 Sep;19(6):1577-1583. doi: 10.1007/s11739-024-03635-2. Epub 2024 May 18.
A systemic inflammatory response occurs during SARS-CoV2 infection and is associated with hypercoagulability and thrombotic events. From March 2020 in our hospital different dosages of low-molecular weight heparin (LMWH) were introduced according to the level of patient care intensity. Because bleeding episodes occurred in hospitalized COVID-19 patients on heparin, the dosage of LMWH at the end of first wave was tailored on the severity of COVID-19. The aim of this study is to describe bleeding and thrombotic events in patients hospitalized with SARS-CoV2 infection on LMWH therapy in the two waves of COVID-19 and analyze the factors associated with these events. Among 1143 patients enrolled in the COVID-19 Network registry, 912 were included in the analysis, 537 of them admitted during the first wave and 375 during the second. Bleeding events were 30 (3.3%): 22 (2.4%) major and 8 (0.9%) non-major. Arterial and venous thrombotic events were 6 (0.7%) and 24 (2.6%). The incidence of venous thrombotic events was higher in the first than in the second wave (0.29% [95% CI 0.20-0.45] events/day vs. 0.05% [95% CI 0.02-0.16]), with a 71% risk reduction (95% CI 22%-94%). The incidence of bleeding was 0.33% (95% CI 0.22-0.50) vs 0.14% events/day (95% CI 0.07-0.28), with no statistical between-wave difference (HR 0.41 95% CI 0.16-1.08). After adjusting for the competing risks of death and comorbidities, patients in the second wave had lower odds to have thrombotic events than in the first wave (0.24 HR [95% C.I. 0.07-0.89]). In this retrospective study on COVID-19 we found a low rate of hemorrhagic and thrombotic events, that may be explained by the absence in the case material of patients admitted to intensive care unit.
在 SARS-CoV2 感染期间会发生全身性炎症反应，与高凝状态和血栓形成事件相关。自 2020 年 3 月起，根据患者护理强度的不同，我院开始使用不同剂量的低分子肝素（LMWH）。由于肝素治疗的 COVID-19 住院患者出现出血事件，因此在第一波疫情结束时，根据 COVID-19 的严重程度调整了 LMWH 的剂量。本研究的目的是描述 COVID-19 网络注册中心登记的 SARS-CoV2 感染住院患者接受 LMWH 治疗的两波 COVID-19 中出血和血栓形成事件，并分析与这些事件相关的因素。在纳入 COVID-19 网络登记中心的 1143 例患者中，912 例纳入分析，其中 537 例在第一波疫情期间入院，375 例在第二波疫情期间入院。出血事件为 30 例（3.3%）：22 例（2.4%）为大出血，8 例（0.9%）为非大出血。动脉血栓形成和静脉血栓形成事件分别为 6 例（0.7%）和 24 例（2.6%）。第一波疫情中静脉血栓形成事件的发生率高于第二波疫情（0.29%[95%CI 0.20-0.45]/天与 0.05%[95%CI 0.02-0.16]/天），风险降低 71%（95%CI 22%-94%）。出血发生率为 0.33%（95%CI 0.22-0.50）/天与 0.14%/天（95%CI 0.07-0.28），两波之间无统计学差异（HR 0.41 95%CI 0.16-1.08）。在调整死亡和合并症的竞争风险后，第二波疫情患者发生血栓形成事件的几率低于第一波疫情（0.24 HR [95%CI 0.07-0.89]）。在这项关于 COVID-19 的回顾性研究中，我们发现出血和血栓形成事件的发生率较低，这可能是由于病例材料中没有收入重症监护病房的患者所致。
