在COVID-19患者中,基于D-二次体的动态血栓预防策略
Lantarima Bhoopat1,2, Anastasia Martynova1, April Choi3
1Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, 90089, USA.
F1000Research
|October 14, 2024
概括
在住院COVID-19患者中根据D-二聚物水平调整抗凝剂剂量,改善了生存率. 这种动态方法显示出比固定的剂量更好的结果,可以控制出血风险.
科学领域:
- 内部医学 内部医学
- 血液学 血液学 血液学
- 传染性疾病 传染性疾病
背景情况:
- 在住院期间,COVID-19感染与静脉血栓塞栓症 (VTE) 的风险增加有关.
- 标准的预防性抗凝药可能不足以减轻这些患者的静脉瘤风险.
- 疫情期间有限的诊断成像需要优化抗凝剂管理协议.
研究的目的:
- 评估基于住院COVID-19患者的D-二次体水平的动态抗凝剂剂量方案的疗效和安全性.
- 为了比较接受固定剂量和动态调整剂量的抗凝剂患者之间的住院生存率.
- 评估二次结果,包括出血事件,血栓发生率和住院时间.
主要方法:
- 追溯队列研究涉及260名住院COVID-19患者.
- 实施质量改进计划,使用D-二聚导向抗凝剂剂量协议.
- 患者被分为固定剂量和动态 (升位) 抗凝剂组.
主要成果:
- 在30天的住院生存时间在升级剂量组 (80.2%) 与固定剂量组 (51.3%) 相比显著更高 (p=0.01).
- 血液事件在升值组 (12.5%) 和固定剂量组 (2.13%) 中更为频繁,主要包括临床相关的非重大出血 (CRNMB).
- 该研究包括突破性血栓形成的评估,停留时间和机械通风天数.
结论:
- 动态的,基于D-二聚体的抗凝剂剂量升级显示出改善住院COVID-19患者的生存率的希望.
- 这种方法可以减少住院死亡率,而不会显著增加致命出血事件.
- 优化抗凝策略对于管理COVID-19患者的VTE风险至关重要.
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