对COVID-19患者出院后静脉血栓塞栓症预防的系统审查
Reza Amani-Beni1, Mohammad Kermani-Alghoraishi2, Bahar Darouei3
1Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
概括
在COVID-19住院治疗后,建议在高风险患者中延长抗凝剂治疗. 使用像IMPROVE-DD这样的工具进行个人评估,以指导直接口服抗凝剂或低分子量肝素治疗的持续时间.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 传染性疾病 传染性疾病
背景情况:
- COVID-19与静脉血栓塞栓症 (VTE) 的风险增加有关,无论是在住院期间还是之后.
- 这种关联引发了人们对抗凝血剂 (AC) 患者在出院后使用的必要性和持续时间的担忧.
研究的目的:
- 系统地审查现有的关于COVID-19患者退院后延长血栓预防治疗的益处和风险的文献.
- 评估该患者群体中抗凝剂选择和持续时间的证据.
主要方法:
- 从2019年12月1日到2022年10月6日,对相关数据库进行了全面的搜索.
- 包括18项研究和19项审查/指南,涉及52,927名住院COVID-19患者,其中19.25%接受了延长血栓预防治疗.
- 使用风险评估模型 (RAM),临床评估和实验室数据来识别高VTE风险患者,IMPROVE-DD是最推的RAM.
主要成果:
- 在0-8.19%的患者 (中位数为0.7%) 发生了VTE事件,平均随访时间为49.5天.
- 大多数研究和指导方针都建议在个人风险评估 (高血栓性,低出血风险) 的基础上进行出院后的预防.
- 直接口服抗凝剂 (DOAC) 和低分子量肝素 (LMWH) 是最常用的抗凝剂类.
结论:
- 建议在个体风险评估后对COVID-19患者进行出院后的预防.
- IMPROVE-DD模型有助于预测VTE风险,指导DOAC (30-35天) 或LMWH (40-45天) 的使用.
- 需要进一步的研究,包括正在进行的RCT;医生还应该考虑与药理治疗一起改变生活方式.
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