COVID-19 Enfekte Hastalarda Tromboembolik Olayların Araştırılması

Yıl 2023, Cilt: 33 Sayı: 1, 56 - 60, 28.02.2023

Serpil Şahin , Hatice Betül Altınışık , Sevil Alkan Çeviker , Uğur Küçük , Havva Yasemin Çinpolat , Uğur Gönlügür

https://doi.org/10.54005/geneltip.1209433

Öz

Amaç: Bu çalışmada, hastaneye yatırılan COVID-19 hastalarında tromboembolik olayların (TEE) sıklığının yanı sıra bu komplikasyonu yaşayan hastaların klinik sonuçları ve hasta özelliklerini belirlemeye çalıştık.
Gereç ve Yöntemler: Ocak 2020 ile Aralık 2021 tarihleri ​​arasında COVID-19 PCR testi pozitif olan tüm hastalar bu çalışmaya dahil edildi. COVID-19 tanısı ile TEE gelişen olguların verileri retrospektif olarak değerlendirildi.
Bulgular: Bu süre zarfında 2.845 yatan hasta COVID-19 ile başvurdu. Bu gruptan 96 hastada (%3,37) COVID-19 ile ilişkili TEE vardı. Ortalama yaş 63,76±13,85 (aralık, 28-80), 46 erkek (%47,92) ve 50 kadın (%52,08) idi. Hastaların 96'sından 46'sında (%47,92) şiddetli COVID-19, 50'sinde (%52,08) sadece hafif solunum semptomları vardı. Şiddetli COVID-19 grubu hastalar daha yaşlıydı ancak gruplar arasında istatistiksel olarak anlamlılık yoktu. Hafif COVID-19 grubunda periferik venöz hastalık daha sık görülürken, şiddetli COVID-19 grubunda periferik arter hastalığı daha yaygındı. Ağır COVID-19 hastalarında CRP, ürik asit, troponin, kreatinin, D-dimer ve lökosit seviyeleri daha yüksekti TEE ile (p<0.05). 96 olgunun 81'inde (%84,37) periferik venöz hastalık, 5'inde (%5,2) periferik arter hastalığı ve 11'inde (%11,45) pulmoner emboli vardı. Bir hastada (%1.04) hem periferik venöz hastalık hem de pulmoner emboli vardı. Genel mortalite %6.25 (6/96) idi.
Sonuç: COVID-19 ile ilişkili trombotik süreç, arterlerden daha sık damarları etkiler. COVID-19'da TEE için önemli gözlemlenen risk göz önüne alındığında, TEE için tanısal görüntüleme yüksek derecede klinik şüphe ile değerlendirilmelidir.

Anahtar Kelimeler

COVID-19, SARS-CoV-2, Thrombosis, Embolism

Investigation of Thromboembolic Events in COVID-19 Infected Patients

Öz

Aim: In this study, we sought to determine patient characteristics and clinical outcomes of patients who experience this complication, as well as the frequency of thromboembolic events (TEE) in COVID-19 patients hospitalized.
Materials and Methods: Between January 2020 and December 2021, all the patients with positive COVID-19 PCR test results were enrolled in this study. The data of the cases that developed TEE with the diagnosis of COVID-19 were evaluated retrospectively.
Results:During this time, 2,845 inpatients were admitted with COVID-19. Among this group, 96 patients (3.37%) had COVID-19 - related TEE. The mean age was 63.76±13.85 years (range, 28–80 years) with 46 men (47.92%) and 50 women (52.08%). Of the patients, 46 of 96 (47.92%) had severe COVID-19, and 50 of 96 (52.08%) had only mild respiratory symptoms. Severe COVID-19 group patients were older but there was not statistically significance between the groups. Peripheral venous disease was more common in mild COVID-19 group, while peripheral arterial disease is more common in severe COVID-19 group.CRP, uric acid, troponin, creatinine,D-dimer and leukocyte levels were higher in severe COVID-19 patients with TEE (p<0.05). Peripheral venous disease was present in 81 of 96 (84.37%), peripheral arterial disease in 5 of 96 (5.2%), and pulmonary embolism in 11 (11.45%) cases. One patient (1.04%) had both peripheral venous disease and pulmonary embolism. The overall mortality was 6.25% (6/96).
Conclusion: COVID-19-associated thrombotic process affects more frequently veins than arteries. Given the significant observed risk for TEE in COVID-19, diagnostic imaging for TEE should be evaluated with a high degree of clinical suspicion.

Anahtar Kelimeler

COVID-19, SARS-CoV-2, Thrombosis, Embolism

Kaynakça

• Vo TD, Daoud A, Jeney A, Andacheh I, Behseresht J, Hsu J,et al. COVID-19-related Peripheral Arterial Thrombosis Treated in a Large Health Maintenance Organization. Ann Vasc Surg. 2022;84:6-11.
• Teuwen LA, Geldhof V, Pasut A, Carmeliet P. COVID-19: the vasculature unleashed. Nat Rev Immunol. 2020; 20:389.
• Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020; 46:1089.
• Abou Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management. Thromb Res. 2020;194:101-15.
• Miesbach W, Makris M. COVID-19: Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation. Clin Appl Thromb Hemost. 2020;26.
• Zuo Y, Estes SK, Ali RA, Gandhi AA, Yalavarthi S, Shi H, et al. Prothrombotic autoantibodies in serum from patients hospitalized with COVID-19. Sci Transl Med. 2020;12:570.
• Al-Ani F, Chehade S, Lazo-Langner A. Thrombosis risk associated with COVID-19 infection. A scoping review. Thromb Res. 2020;192:152–60.
• Huang C, Wang Y, Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China Lancet 2020;395(10223):497–506.
• Danzi G B, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association? Eur Heart J. 2020;41(19):1858
• Chen N, Zhou M, Dong X. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet.2020;395(10223):507–13.
• Dobesh PP, Trujillo TC. Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID-19. Pharmacotherapy. 2020;40(11):1130-51.
• Ozsu S, Gunay E, Konstantinides SV. A review of venous thromboembolism in COVID-19: A clinical perspective. Clin Respir J. 2021;15(5):506-12.
• Indes JE, Koleilat I, Hatch AN, Choinski K, Jones DB, Aldailami H, et al. Early experience with arterial thromboembolic complications in patients with COVID-19. J Vasc Surg. 2021;73(2):381-9.
• Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al; Global COVID-19 Thrombosis Collaborative Group, Endorsed by the ISTH, NATF, ESVM, and the IUA, Supported by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;75(23):2950-73.
• Lagunas-Rangel FA. Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. J Med Virol. 2020; 92(10):1733-34.
• Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE, Tan GB, Mucheli SS, Kuperan P, Ong KH. Hematologic parameters in patients with COVID-19 infection. Am J Hematol. 2020 ;95(6):131-4.
• Alkan S, Şener A, Doğan E, Yüksel C, Yüksel B. Prophylactic Anticoagulant Treatment Might Have an Anti-inflammatory Effect and Reduce Mortality Rates in Hospitalized COVID-19 Patients? Oman Med J. 2022;37(4):394.
• Barnes GD, Burnett A, Allen A, Blumenstein M, Clark NP, Cuker A, et al. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J Thromb Thrombolysis. 2020;50(1):72-81.
• Dobesh P. The importance of appropriate prophylaxis for the prevention of venous thromboembolism in at‐risk medical patients. Int J Clin Pract. 2010;64:1554–62.
• Attia J, Ray JG, Cook DJ, Douketis J, Ginsberg JS, Geerts WH. Deep vein thrombosis and its prevention in critically ill adults. Arch Intern Med. 2001;161:1268–79.
• Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020;18:1421–4.
• Zhang L, Feng X, Zhang D, Jiang C, Mei H, Wang J, et al. Deep Vein Thrombosis in Hospitalized Patients With COVID-19 in Wuhan, China: Prevalence, Risk Factors, and Outcome. Circulation. 2020;142(2):114-28.
• Poissy J, Goutay J, Caplan M, Parmentier E, Duburcq T, Lassalle F, et al; Lille ICU Haemostasis COVID-19 Group. Pulmonary Embolism in Patients With COVID-19: Awareness of an Increased Prevalence. Circulation. 2020;142(2):184-6.
• Beun R, Kusadasi N, Sikma M, Westerink J, Huisman A. Thromboembolic events and apparent heparin resistance in patients infected with SARS‐CoV‐2. Int J Lab Hematol.2020;42(1):19–20.
• Demelo-Rodríguez P, Cervilla-Muñoz E, Ordieres-Ortega L, Parra-Virto A, Toledano-Macías M, Toledo-Samaniego N, et al. Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels. Thromb Res. 2020;192:23-6.
• Maatman TK, Jalali F, Feizpour C, Douglas A 2nd, McGuire SP, Kinnaman G, et al. Routine Venous Thromboembolism Prophylaxis May Be Inadequate in the Hypercoagulable State of Severe Coronavirus Disease 2019. Crit Care Med. 2020;48(9):783-90.
• Santoliquido A, Porfidia A, Nesci A, De Matteis G, Marrone G, Porceddu E, et al; GEMELLI AGAINST COVID-19 Group, D'Alfonso ME, Lo Monaco MR. Incidence of deep vein thrombosis among non-ICU patients hospitalized for COVID-19 despite pharmacological thromboprophylaxis. J Thromb Haemost. 2020;18(9):2358-63.
• Criel M, Falter M, Jaeken J, Van Kerrebroeck M, Lefere I, Meylaerts L, et al. Venous thromboembolism in SARS-CoV-2 patients: only a problem in ventilated ICU patients, or is there more to it? Eur Respir J. 2020;56(1):200-1