在COVID后的全关节置换患者中增加抗凝剂需求:印度人口的比较研究
Anteshwar Birajdar1, Mukesh Phalak1, Tushar Chaudhari1
1Department of Orthopaedic, D.Y. Patil Medical Hospital and Research Centre, Pune, Maharashtra, India.
Journal of orthopaedic case reports
|July 10, 2025
概括
由于凝血风险增加,COVID-19后接受全关节置换 (THR) 的患者需要更高剂量的低分子量肝素 (LMWH). 调整后的LMWH在不引起出血并发症的情况下是有效的,这凸显了针对性抗凝药的需要.
科学领域:
- 整形外科手术 整形外科手术
- 血管医学 血管医学
- 传染病流行病学 传染病流行病学
背景情况:
- 全球范围内,COVID-19大流行影响了血管和凝血系统.
- 印度不受监管的传统疗法使医疗记录和风险评估复杂化.
- 对关节全置换 (THR) 等手术的术后风险评估受到与流行病相关的变化的影响.
研究的目的:
- 为了比较在COVID-19大流行之前和之后接受THR的患者的低分子量肝素 (LMWH) 需求.
- 评估在后COVID时代与THR相关的血栓和出血风险.
- 为了确定影响THR患者流行后抗凝血需求的因素.
主要方法:
- 一项回顾性队列研究,对150名接受选择性THR的患者进行了回顾性队列研究,分为COVID前 (2018-2019) 和COVID后 (2022-2024) 组.
- 数据收集包括人口统计,并发症,LMWH剂量和持续时间,实验室值 (D-二次数,PT) 和结果 (DVT,PE,出血).
- 统计分析包括t测试,Chi平方测试和后勤回归来比较队列并确定风险因素.
主要成果:
- 后COVID组需要显著更高的LMWH剂量 (77.3%与42.7%,P<0.00001).
- 深静脉血栓 (DVT) 的发生率在COVID后队列中较高 (17.3%对4.0%,P = 0.01).
- 出血并发症没有显著不同;高的D-二次体和PT在COVID后持续存在. 后COVID状态是增加抗凝血需求的独立风险因素 (OR = 2.34,P = 0.02).
结论:
- 在后COVID时代接受THR的患者表现出前血栓状况,可能是由于持续的内皮功能障碍或SARS-CoV-2感染的凝血病.
- 增加LMWH剂量是必要的,以管理高血栓形成风险,而不会增加出血并发症.
- 个性化的抗凝血方案和警的术后监测对于优化COVID后骨科患者的结果至关重要.
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