COVID-19和妊娠均与高凝状态有关。由于血栓形成的风险增加,美国国立卫生研究院对妊娠患者预防性使用抗凝药物的建议已从因严重COVID-19表现住院的患者扩展到所有因COVID-19表现住院的患者(无指南:2020年12月26日之前;第一次更新:2022年12月27日;第二次更新:2022年2月24日至今).然而,没有研究对这一建议进行评估.
这项研究的目的是描述2020年3月20日至2022年10月19日期间COVID-19住院孕妇的预防性抗凝剂使用情况。
这是一项针对美国7个州的大型医疗保健系统的回顾性队列研究。感兴趣的队列是因COVID-19住院的妊娠患者,既往无凝血障碍或抗凝剂禁忌症(n=2767)。治疗组包括在COVID-19治疗开始前2天至后14天之间处方预防剂量抗凝的患者(n=191)。对照组为COVID-19治疗前14天至治疗后60天未接触抗凝药物的患者(n=2534)。我们确定了预防性抗凝剂的使用,并注意了指南的更新和新出现的SARS-CoV-2变体。在有助于预防性抗凝剂给药状态分类的最重要特征上,我们的倾向评分与治疗组和对照组1:1相匹配。结果指标包括凝血障碍,出血,COVID-19相关并发症,和母胎健康结局。此外,住院抗凝剂给药率在Truveta的全国人群中得到验证,全美700家医院。
预防性抗凝剂的总给药率为7%(191/2725)。第二次指南更新后最低(无指南:27/262,10%;第一次更新:145/1663,8.72%;第二次更新:19/811,2.3%;P<.001)和在omicron-优势期(野生型:45/549,8.2%;Alpha:18/129,14%;Delta:81/507,16%;Omicron:47/1551,3%;P<.001)根据回顾性数据开发的模型表明,与住院预防性抗凝剂的施用最相关的变量是SARS-CoV-2感染之前的合并症。接受预防性抗凝剂的患者也更有可能接受补充氧气(57/191,30%vs9/188,5%;P<.001)。凝血病的新诊断没有统计学差异,出血,或接受治疗的患者与匹配的对照组之间的母胎健康结局。
大多数住院妊娠COVID-19患者没有按照指南的建议在整个医疗保健系统中接受预防性抗凝剂。指南推荐的治疗更频繁地用于COVID-19疾病严重程度更高的患者。考虑到低给药速率和治疗和未治疗队列之间的差异,无法评估疗效。
Both COVID-19 and pregnancy are associated with hypercoagulability. Due to the increased risk for thrombosis, the United States National Institute of Health\'s recommendation for prophylactic anticoagulant use for pregnant patients has expanded from patients hospitalized for severe COVID-19 manifestation to all patients hospitalized for the manifestation of COVID-19 (no
guideline: before December 26, 2020; first update: December 27, 2022; second update: February 24, 2022-present). However, no study has evaluated this recommendation.
The objective of this study was to characterize prophylactic anticoagulant use among hospitalized pregnant people with COVID-19 from March 20, 2020, to October 19, 2022.
This was a retrospective cohort study in large US health care systems across 7 states. The cohort of interest was pregnant patients who were hospitalized with COVID-19, without previous coagulopathy or contraindication to anticoagulants (n=2767). The treatment group consisted of patients prescribed prophylactic dose anticoagulation between 2 days before and 14 days after COVID-19 treatment onset (n=191). The control group was patients with no anticoagulant exposure between 14 days before and 60 days after COVID-19 treatment onset (n=2534). We ascertained the use of prophylactic anticoagulants with attention to the updates in
guidelines and emerging SARS-CoV-2 variants. We propensity score matched the treatment and control group 1:1 on the most important features contributing to the prophylactic anticoagulant administration status classification. Outcome measures included coagulopathy, bleeding, COVID-19-related complications, and maternal-fetal health outcomes. Additionally, the inpatient anticoagulant administration rate was validated in a nationwide population from Truveta, a collective of 700 hospitals across the United States.
The overall administration rate of prophylactic anticoagulants was 7% (191/2725). It was lowest after the second
guideline update (no
guideline: 27/262, 10%; first update: 145/1663, 8.72%; second update: 19/811, 2.3%; P<.001) and during the omicron-dominant period (Wild type: 45/549, 8.2%; Alpha: 18/129, 14%; Delta: 81/507, 16%; and Omicron: 47/1551, 3%; P<.001). Models developed on retrospective data showed that the variable most associated with the administration of inpatient prophylactic anticoagulant was comorbidities prior to SARS-CoV-2 infection. The patients who were administered prophylactic anticoagulant were also more likely to receive supplementary oxygen (57/191, 30% vs 9/188, 5%; P<.001). There was no statistical difference in a new diagnosis of coagulopathy, bleeding, or maternal-fetal health outcomes between those who received treatment and the matched control group.
Most hospitalized pregnant patients with COVID-19 did not receive prophylactic anticoagulants across health care systems as recommended by
guidelines.
Guideline-recommended treatment was administered more frequently to patients with greater COVID-19 illness severity. Given the low rate of administration and differences between treated and untreated cohorts, efficacy could not be assessed.