新型冠状病毒肺炎患者的静脉血栓栓塞症风险评估与抗凝治疗

VTE risk assessment and anticoagulant therapy in COVID-19 patients

目的评估新型冠状病毒肺炎(简称新冠肺炎)患者的静脉血栓栓塞症(VTE)风险与药物性抗凝治疗。方法收集并分析2020年2月9日至2020年3月29日期间收治于武汉同济医院光谷院区的新型冠状病毒肺炎患者的临床资料、血凝常规等资料。每位患者在入院24 h内进行Padua评分。分析患者Padua评分与患者疾病严重程度和28天预后的关系。结果共收集分析102例新冠肺炎确诊患者的临床资料。重型组的Padua评分高于普通型组(2.5±1.0比2.1±0.4,P=0.201),但无统计学差异。危重型组的Padua评分(6.2±1.1比2.5±1.0,P<0.001)、抗凝比例(52.6%比7.1%,P<0.001)、死亡率(57.8%比4.3%,P<0.001)均明显升高于重型患者,其凝血酶原时间、活化部分凝血活酶时间、D-二聚体较重型组也明显升高。以Padua评分4分为界,分为VTE高风险组(≥4分)和VTE低风险组(<4分)。VTE高风险组的死亡率、活化部分凝血活酶时间、D-二聚体、纤维蛋白原均明显高于VTE低风险组。在VTE高风险组中,抗凝比例明显高于VTE低风险组(41.7%比6.4%,P<0.001),但仍仅有41.7%。VTE高风险患者中,抗凝者的死亡率低于未抗凝治疗者(30%比42.8%,P=0.52),但差异无统计学意义。结论重型和危重型的新冠肺炎患者VTE风险明显升高,对于这类VTE高风险患者进行预防性抗凝治疗可能降低死亡率,但仍需要更多循证医学证据。

Objective To evaluate the venous thromboembolism(VTE) risk and anticoagulant therapy in patients with coronavirus disease 2019(COVID-19). Methods The patients with COVID-19 in Optics Valley Hospital of Wuhan Tongji Hospital from February 9, 2020 to March 29, 2020 were collected and analyzed. Padua scores were performed within 24 hours after admission. The relationship between Padua score, disease severity and 28 day prognosis was analyzed. Results COVID-19 was diagnosed in 102 cases. The age, fibrinogen and mortality of the severe group were significantly higher than those of the common group. The Padua score of the severe group was higher than that of the common group, but there was no statistical difference. The platelet count in the critical group was significantly lower than that in the severe group, while the prothrombin time(PT), activated partial thromboplastin time(APTT), and D dimer were significantly higher than that in the severe group, and the Padua score, anticoagulation ratio, and mortality were significantly higher than those in the severe group. According to Padua score 4, it was divided into VTE high risk group(≥ 4 points) and VTE low risk group(<4 points). The mortality, APTT, D dimer and fibrinogen of high risk group were significantly higher than those of low risk group. In the high-risk group of VTE, the anticoagulation rate was significantly higher than that in the low-risk group of VTE, but it was still only 41.7%. The mortality of patients with anticoagulation was lower than that of patients without anticoagulation. Conclusions Severe and critical novel coronavirus pneumonia patients have obvious coagulation dysfunction and high risk of VTE. Anticoagulant therapy may be associated with low mortality in patients with high risk of VTE, but the proportion of drug-induced anticoagulant intervention still needs to be improved.