Pop Călin, Hermenean Anca, Moș Liana, Cotoraci Coralia
Department of Biology and Health Sciences, Faculty of Medicine Arad, "Vasile Goldis" West University, 310048 Arad CP, Romania.
Rev Cardiovasc Med. 2022 Jun 20;23(6):219. doi: 10.31083/j.rcm2306219. eCollection 2022 Jun.
Venous thromboembolic (VTE) events have been increasingly reported in patients with coronavirus disease 2019 (COVID-19) after hospital discharge. Acute pulmonary embolism (PE) is the most frequent type of post-discharge VTE complication. Levels of procoagulants (fibrinogen, factor VIII, von Willebrand factor), and D-dimer are higher during the SARS-CoV-2 infection. Patients with more severe inflammatory and procoagulant response experience higher VTE rates during hospitalization, while the risk after hospital discharge have not been well characterized. The incidence of VTE events following hospitalization is heterogeneous, ranging from low (3.1 per 1000 discharges), to 1.8%, which appears higher than for other medical condition. This discrepancy was partially explained by the differences in VTE screening and follow-up strategies, and by the period when the information about the VTE was collected. These data were based mainly on observational and retrospective studies; however, evolving data are to come after the completion of the prospective trials. The current guidelines do not recommend routine post-hospital VTE prophylaxis for COVID-19 patients but recommend it for all hospitalized adults. A careful risk-benefit assessment of VTE probability should be performed, to determine whether an individual patient may merit post-discharge thromboprophylaxis. A score such IMPROVE DD can help identify the patient who will potentially benefit but is also important to consider the bleeding risk and the feasibility. The optimal duration and the type of extended thromboprophylaxis is still under debate (from a minimum of 14 days to a maximum of 42 days), and future studies will help to validate these protocols in different populations. Direct oral anticoagulants (DOACs), warfarin and low molecular weight heparin (LMWH) are recommended, but low doses of DOACs rather than LMVH or warfarin were predominantly used in most patients. Finally, the COVID-19 patients should be educated to recognize and advised to seek urgent medical care should VTE events occur after hospital discharge.
2019冠状病毒病（COVID-19）患者出院后静脉血栓栓塞（VTE）事件的报告日益增多。急性肺栓塞（PE）是出院后VTE并发症最常见的类型。在严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染期间，促凝剂（纤维蛋白原、凝血因子VIII、血管性血友病因子）和D-二聚体水平较高。炎症和促凝反应更严重的患者在住院期间VTE发生率更高，而出院后的风险尚未得到充分描述。住院后VTE事件的发生率存在异质性，从低（每1000例出院患者中有3.1例）到1.8%不等，这似乎高于其他疾病。这种差异部分是由于VTE筛查和随访策略的不同，以及收集VTE信息的时间段不同。这些数据主要基于观察性和回顾性研究；然而，前瞻性试验完成后还会有不断演变的数据。目前的指南不建议对COVID-19患者进行常规出院后VTE预防，但建议对所有住院成人进行预防。应进行VTE可能性的仔细风险效益评估，以确定个别患者是否值得出院后进行血栓预防。IMPROVE DD等评分有助于识别可能受益的患者，但考虑出血风险和可行性也很重要。延长血栓预防的最佳持续时间和类型仍在争论中（从最短14天到最长42天），未来的研究将有助于在不同人群中验证这些方案。推荐使用直接口服抗凝剂（DOACs）、华法林和低分子肝素（LMWH），但大多数患者主要使用低剂量的DOACs而非低分子肝素或华法林。最后，应教育COVID-19患者识别VTE事件，并建议他们在出院后发生VTE事件时寻求紧急医疗护理。
