Abstract：
Therapeutic anticoagulation showed inconsistent results in hospitalized patients with COVID-19 and selection of the best patients to use this strategy still a challenge balancing the risk of thrombotic and hemorrhagic outcomes. The present post-hoc analysis of the ACTION trial evaluated the variables independently associated with both bleeding events (major bleeding or clinically relevant non-major bleeding) and the composite outcomes thrombotic events (venous thromboembolism, myocardial infarction, stroke, systemic embolism, or major adverse limb events). Variables were assessed one by one with independent logistic regressions and final models were chosen based on Akaike information criteria. The model for bleeding events showed an area under the curve of 0.63 (95% confidence interval [CI] 0.53 to 0.73), while the model for thrombotic events had an area under the curve of 0.72 (95% CI 0.65 to 0.79). Non-invasive respiratory support was associated with thrombotic but not bleeding events, while invasive ventilation was associated with both outcomes (Odds Ratio of 7.03 [95 CI% 1.95 to 25.18] for thrombotic and 3.14 [95% CI 1.11 to 8.84] for bleeding events). Beyond respiratory support, creatinine level (Odds Ratio [OR] 1.01 95% CI 1.00 to 1.02 for every 1.0 mg/dL) and history of coronary disease (OR 3.67; 95% CI 1.32 to 10.29) were also independently associated to the risk of thrombotic events. Non-invasive respiratory support, history of coronary disease, and creatinine level may help to identify hospitalized COVID-19 patients at higher risk of thrombotic complications.ClinicalTrials.gov: NCT04394377.
摘要：
在COVID-19住院患者中，治疗性抗凝治疗的结果不一致，选择使用该策略的最佳患者仍然是平衡血栓形成和出血性结局风险的挑战。当前ACTION试验的事后分析评估了与出血事件（大出血或临床相关的非大出血）和复合结局血栓事件（静脉血栓栓塞，心肌梗塞,中风,全身性栓塞,或重大不良肢体事件)。使用独立逻辑回归逐一评估变量，并根据Akaike信息标准选择最终模型。出血事件模型显示曲线下面积为0.63（95％置信区间[CI]0.53至0.73），而血栓事件模型的曲线下面积为0.72(95%CI0.65~0.79).非侵入性呼吸支持与血栓形成相关，但与出血事件无关。有创通气与两种结局相关(血栓形成的几率为7.03[95CI%1.95~25.18],出血事件的几率为3.14[95%CI1.11~8.84]).除了呼吸支持，肌酐水平(OddsRatio[OR]1.0195%CI1.00~1.02,每1.0mg/dL)和冠心病病史(OR3.67;95%CI1.32~10.29)也与血栓形成事件的风险独立相关.非侵入性呼吸支持，冠心病史,和肌酐水平可能有助于识别血栓并发症风险较高的住院COVID-19患者.ClinicalTrials.gov：NCT04394377。
