Victorin David, Bergquist Henrik, Hafsten Louise, Nihlén Åsa, Lindell Ellen
Department of Otorhinolaryngology Region Västra Götaland, Södra Älvsborg Hospital Borås Sweden.
Department of Research, Education and Innovation Region Västra Götaland, Södra Älvsborg Hospital Borås Sweden.
Laryngoscope Investig Otolaryngol. 2025 Apr 2;10(2):e70122. doi: 10.1002/lio2.70122. eCollection 2025 Apr.
The aim of this study was to analyze whether patients with SARS-CoV-2 who received surgical tracheotomy had a lower incidence of postoperative bleeding if their LMWH was postponed or canceled on the day of surgery.
Patients with SARS-CoV-2 admitted to the intensive care units who underwent surgical tracheotomy were assessed retrospectively through their medical records. Data on comorbidity, LMWH dose, and timing were collected. Bleedings < 72 h post surgery were noted as stomal or airway bleedings.
All 101 patients included were on LMWH. Twenty-two patients had no change of dose of LMWH, 24 patients had their dose of LMWH postponed to post surgery, and 50 patients had their dose reduced to only the evening dose on the day of surgery. Twenty-six patients had a stomal bleeding, one patient had an airway bleeding, and four patients had both stomal and airway bleedings. No significant difference in the incidence of bleeding was identified between various groups of different LMWH doses or timing, reduced dose versus no change of dose, OR 1.29 (95% CI 0.42-3.92). Postponed dose versus no change of dose of LMWH, OR 1.03 (95% CI 0.28-3.75). Increasing age was correlated to a higher risk of bleeding post-surgery by an OR of 1.64 (95% CI 1.06-2.54, = 0.026 for every 10 years added). No fatal bleeding related to surgical tracheotomy was observed.
Decreased doses of LMWH on the day of surgery were not associated with a risk reduction for post-surgical bleeding in patients with SARS-CoV-2 who received tracheotomy. Increasing age was a risk factor for post-surgical bleeding.
Retrospective, level 3.
本研究旨在分析接受外科气管切开术的新型冠状病毒肺炎（SARS-CoV-2）患者，若在手术当天推迟或停用低分子肝素（LMWH），术后出血发生率是否更低。
对入住重症监护病房并接受外科气管切开术的SARS-CoV-2患者，通过病历进行回顾性评估。收集合并症、LMWH剂量和用药时间的数据。术后<72小时的出血记为造口或气道出血。
纳入的101例患者均使用LMWH。22例患者LMWH剂量无变化，24例患者LMWH剂量推迟至术后，50例患者在手术当天仅将剂量减至晚间剂量。26例患者发生造口出血，1例患者发生气道出血，4例患者同时发生造口和气道出血。不同LMWH剂量组或用药时间组（减量与未改变剂量）之间，出血发生率无显著差异，比值比（OR）为1.29（95%置信区间[CI]0.42 - 3.92）。LMWH剂量推迟与未改变剂量相比，OR为1.03（95%CI0.28 - 3.75）。年龄增加与术后出血风险增加相关，每增加10岁，OR为1.64（95%CI1.06 - 2.54，P = 0.026）。未观察到与外科气管切开术相关的致命性出血。
对于接受气管切开术的SARS-CoV-2患者，手术当天减少LMWH剂量与降低术后出血风险无关。年龄增加是术后出血的危险因素。
回顾性研究，3级。
