奥密克戎感染重症患者血栓事件特点及预防性低分子肝素的疗效探讨
The characteristics of thrombosis in severe patients with omicron infection and the therapeutic value of preventive low molecular weight heparin
王军红 1张华 2董淑杰 3付源伟 1曾琳 2赵荣生 3马青变1
作者信息
- 1. 北京大学第三医院急诊科(北京 100191)
- 2. 北京大学第三医院临床流行病学中心(北京 100191)
- 3. 北京大学第三医院药剂科(北京 100191)
- 折叠
摘要
目的 探讨奥密克戎变异株感染重症患者的血栓特点及预防性低分子肝素的疗效.方法 采用单中心回顾性队列研究,纳入2022年12月7 日-2023年2月8日北京大学第三医院收治的新型冠状病毒奥密克戎变异株感染的成年危重患者.根据预防性低分子肝素将患者分为两组.倾向性评分(propensity score,PS)匹配用于基于预定义标准匹配患者(1∶1比例),比较一般临床信息和实验室参数.本研究在中国临床试验注册中心进行了回顾性注册(ChiCTR230067434).结果 纳入452例患者,经PS匹配后每组180例患者.PS匹配前后,预防性抗凝组和非预防性抗凝组在病死率、肺栓塞、动脉血栓形成和出血发生率方面差异无统计学意义.82例(18.14％)患者发生91次血栓事件,其中最常见的是下肢肌间静脉血栓54例(59.34％),肺栓塞、急性心肌梗死以及急性脑梗死分别发生3例(3.30％)、14例(15.38％)和3例(3.30％).血栓事件导致5例患者死亡.D-二聚体升高385例(85.56％),在第1、3、6和9天,预防性抗凝组的D-二聚体浓度高于非预防性抗凝组(分别为P=0.006、0.001、0.024和0.006).结论 血栓事件及凝血功能异常虽然仍是奥密克戎变异株感染重症患者的常见并发症,但并非患者死亡的直接原因.预防性抗凝治疗对奥密克戎变异株感染患者的作用尚待进一步研究.
Abstract
Objectives To explore the characteristics of thrombosis in critically ill patients with Omicron infection and the therapeutic value of prophylactic low molecular weight heparin(LMWH)treatment.Methods A single center,retrospective cohort study included critically ill adult patients with Omicron variant of SARS-CoV-2 admitted to Peking University Third Hospital from December 7,2022,to February 8,2023.The patients were categorized into two groups based prophylactic LMWH.Propensity score(PS)matching was used to match patients(1∶1 ratio)based on the predefined criteria.General clinical information and laboratory parameters were compared.This study was retrospectively registered at Chinese Clinical Trail Registry(ChiCTR2300067434).Results Four hundred and fifty-two patients and 360 patients were included before and after PS matching.There were no statistical differences in mortality,the incidence of pulmonary embolism,arterial thrombosis or bleeding between the anticoagulation group and non-coagulation group before and after PS matching.There were 91 thrombotic events in 82 patients(18.14％),of which 54 cases(59.34％)were lower limb intermuscular vein thrombosis,3 cases(3.30％)were pulmonary embolism,14 cases(15.38％)were acute myocardial infarction and 3 cases(3.30％)were acute cerebral infarction.The thrombotic event resulted in the death of 5 patients.D-dimer increased in 385 cases(85.56％).On the 1st,3rd,6th and 9th day,the concentration of D-dimer in the anticoagulant group was higher than that in the non-anticoagulant group(P=0.006,0.001,0.024 and 0.006,respectively).Conclusions Although thrombosis and coagulation disorders are still common complications of COVID-19,it is not the direct cause of most death in COVID-19 patients caused by Omicron.The role of prophylactic anticoagulation treatment for Omicron-infected patients needs further study.
关键词
严重急性呼吸系统综合征冠状病毒2型/低分子肝素/危重症/血栓/病死率Key words
SARS-CoV-2/low molecular weight heparin/critically ill/thrombosis/mortality引用本文复制引用
基金项目
北京大学第三医院临床队列建设项目(BYSYDL2023001-15)
北京大学第三医院临床队列建设项目(BYSYDL2023001-08)
国家临床重点专科建设项目(2022)()
出版年
2024
NETL
NSTL
万方数据