背景研究表明,COVID-19感染可能导致高凝状态增加,导致血栓性并发症.在接受标准剂量深静脉血栓形成(DVT)预防的患者中,血栓并发症的发生率很高,这促使一些临床医生支持经验性增加用于COVID-19患者预防的抗凝(AC)剂量。目前,最佳抗凝剂,剂量,和持续时间尚未指定。我们进行了一项回顾性研究,根据各种AC剂量评估接受COVID-19治疗的患者的预后。方法这是一个单一的机构,回顾性横断面研究,包括2020年9月至11月在圣约瑟夫健康网络中入院的COVID-19检测阳性患者。纳入标准是通过聚合酶链反应(PCR)确认COVID-19的18岁或以上的男性和女性。对符合纳入标准的患者的医学图表进行审核以获取信息。将患者分为三组:接受DVT预防剂量AC的患者,那些接受中等剂量AC的人,以及那些接受治疗AC的人。结果共纳入440例患者,其中236人是西班牙裔(50.3%),131人是白种人(27.1%),47人是非裔美国人(10.7%),亚洲人中有26人(5.9%)。最常见的合并症是高血压(273/440[62.2%]),糖尿病189/440[43.1%]),和冠状动脉疾病(60/440[13.7%])。在AC队列的DVT预防剂量中,有215个病人,平均住院时间为10.3天。11例患者出现出血事件,5例患者发生血栓性事件,16例患者需要机械通气,20名患者死亡。在中间剂量的AC队列中,有63个病人,平均住院时间为10.3天。3例患者出现出血事件,两名患者出现血栓性事件,七名患者需要机械有创通气,11名患者死亡。在AC队列的治疗剂量中,有162名患者,平均住院时间为14天。在这个队列中,19例患者发生出血事件,12例患者发生血栓性事件,26例患者需要有创机械通气,29名患者死亡。接受中等剂量AC的患者发生血栓事件的风险也最低(0.05)。接受中等剂量AC的患者需要高流量鼻插管(p=0.0001)和有创机械通气(p=0.031)的比率最低。与接受DVT预防剂量和全身AC剂量的患者相比,接受中等剂量AC的患者出血率较低(p=0.037)。与全身性AC组相比,AC组的DVT预防性和中间给药具有更短的住院时间(p=0.0002)。结论与静脉血栓栓塞预防剂量和全身AC剂量组相比,中间剂量AC的出血率最低,死亡率,逗留时间,以及高流量鼻插管或机械有创通气的要求。在全身剂量AC组中,就住院时间而言,临床结果较差,出血事件的发生率,机械呼吸机使用要求,和死亡率。
Background Studies suggest that COVID-19 infection may induce increased hypercoagulability, leading to thrombotic complications. The high rates of thrombotic complications among patients receiving standard-dose deep venous thrombosis (DVT) prophylaxis have prompted some clinicians to support the empiric increase of anticoagulation (AC) doses used for prophylaxis in patients with COVID-19. At present, the optimal anticoagulant agents, dosages, and duration have not been designated. We conducted a retrospective study to assess for outcomes in patients who received treatment for COVID-19 based on various dosings of AC. Methods This was a single-institution, retrospective cross-sectional study including patients with a positive COVID-19 test who were admitted within the St. Joseph\'s Health Network from September to November of 2020. The inclusion criteria were men and women aged 18 years or older who had confirmed COVID-19 by polymerase chain reaction (PCR). Medical charts of patients who met the inclusion criteria were audited to obtain information. The patients were separated into three cohorts: those who received DVT prophylactic dose of AC, those who received an intermediate dose of AC, and those who received therapeutic AC. Results A total of 440 patients were included in the study, of whom 236 were Hispanic (50.3%), 131 were Caucasian (27.1%), 47 were African American (10.7%), and 26 were Asian (5.9%). The most common comorbidities were hypertension (273/440 [62.2%]), diabetes 189/440 [43.1%]), and coronary artery disease (60/440 [13.7%]). In the DVT prophylactic dose of AC cohort, there were 215 patients, and the average length of stay was 10.3 days. Eleven patients experienced bleeding events, five patients experienced thrombotic events, 16 patients required mechanical ventilation, and 20 patients died. In the intermediate dose of AC cohort, there were 63 patients, and the average length of stay was 10.3 days. Three patients experienced bleeding events, two patients experienced thrombotic events, seven patients required mechanical invasive ventilation, and 11 patients died. In the therapeutic dose of AC cohort, there were 162 patients, and the average length of stay was 14 days. In this cohort, 19 patients experienced bleeding events, 12 patients experienced thrombotic events, 26 patients required invasive mechanical ventilation, and 29 patients died. Patients who received intermediate dosing of AC also had the lowest risk of thrombotic events (0.05). Patients who received intermediate dosing of AC had the lowest rates of requiring both high-flow nasal cannula (p = 0.0001) and invasive mechanical ventilation (p = 0.031). Patients who received intermediate dosing of AC had a lower rate of bleeding compared to those who received the DVT prophylaxis dose and systemic AC dose (p = 0.037). The DVT prophylactic and intermediate dosing of AC groups had a shorter length of stay in comparison to the systemic AC group (p = 0.0002). Conclusion In comparison to the venous thromboembolism prophylaxis dose and systemic AC dose groups, intermediate dosing of AC had the lowest rates of hemorrhage, mortality, length of stay, and requirement of high-flow nasal cannula or mechanical invasive ventilation. In the systemic dose AC group, there were worse clinical outcomes in terms of length of stay, incidence of bleeding events, requirement of mechanical ventilator use, and rate of mortality.