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DOI: 10.1055/a-2212-9676
Thrombosehäufigkeit bei ambulanten Post-COVID-Patienten
Prospektive Beobachtungsstudie in einer phlebologischen SchwerpunktpraxisIncidence of Thrombosis in Post-COVID OutpatientsProspective Observational Study in a Phlebology-focused PracticeAuthors
Zusammenfassung
Ziel der Studie Ziel dieser prospektiven Pilotstudie war es, im ambulanten Krankengut einer phlebologischen Schwerpunktpraxis zu ermitteln, ob im Intervall 2–4 Monate post-COVID mit einer erhöhten Inzidenz thromboembolischer Ereignisse zu rechnen ist.
Methodik Im Rahmen einer systematischen Nachuntersuchung von COVID-Folgeerkrankungen wurden 103 konsekutive Patienten zur Teilnahme an einer phlebologischen Untersuchung eingeschlossen. Diese umfasste nach einem standardisierten Untersuchungsprotokoll neben der Anamnese die Bestimmung der klinischen Wahrscheinlichkeit nach Wells, die komplette Kompressions- und Farbduplexsonografie und die laborchemische Bestimmung der D-Dimere.
Ergebnisse Insgesamt ließen sich 4 thrombotische Ereignisse nachweisen (3,9%). Davon betrafen 2 das tiefe (1,9%) und 2 das oberflächliche (1,9%) Beinvenensystem. In Bezug auf das durchschnittliche Patientengut der phlebologischen Schwerpunktpraxis (TVT-Häufigkeit von 1,48%) ergab sich jedoch keine signifikante TVT-Häufung in dem hier untersuchten Kollektiv (p=0,69).
Schlussfolgerung Die auffällige, aber insgesamt relativ niedrige Inzidenz von Thrombosen als Folge einer SARS-CoV-2-Infektion stützt die Annahme, dass Patienten mit erhöhtem Thromboserisikoprofil nicht nur in der Akutphase der COVID-Infektion, sondern auch noch nach 2–4 Monaten post-COVID einer vermehrten Aufmerksamkeit bedürfen.
Abstract
Purpose The aim of this prospective pilot study was to evaluate whether an increased incidence of thromboembolic events can be expected in the interval of two to four months post-COVID in the outpatient population of a phlebology-focused practice.
Methods As part of a systematic follow-up study of COVID sequelae, 103 consecutive patients were included for participation in a phlebological examination. Following a standardized examination protocol, this included the medical history, the determination of clinical probability according to Wells, complete compression (CCUS) and colour coded duplex ultrasound as well as the determination of D-dimers.
Results A total of four thrombotic events could be detected (3.9%). Of these, two involved the deep (1.9%) and two involved the superficial (1.9%) leg vein system. In relation to the average patient population of the phlebological specialized practice (DVT frequency of 1.48%), there was no significant increase of DVT in this study group (p=0.69).
Conclusion The striking but in total relatively low incidence of thrombosis secondary to survived SARS-CoV-2 infection supports the hypothesis that patients with an increased thrombosis risk profile require increased attention not only in the acute phase of COVID infection, but also 2–4 months post-COVID.
Schlüsselwörter
venöse Thromboembolie (VTE) - Thrombosehäufigkeit - Post-COVID-Syndrom (PCS) - ambulante Patienten mit SARS-CoV-2-InfektionKeywords
venous thromboembolism (VTE) - incidence of thrombosis - post-COVID syndrome (PCS) - outpatients with SARS-CoV-2 infectionPublication History
Article published online:
14 August 2024
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Literatur
- 1 Ho FK, Kenneth KC, Toshner M. et al. Thromboembolic Risk in Hospitalizedand Nonhospitalized COVID-19 Patients: A Self-Controlled Case Series Analysis of a Nationwide Cohort. Mayo Clin Proc 2021; 96 (10) 2587-2597
- 2 Di Minno A, Ambrosino P, Calcaterra I. et al. COVID-19 and Venous Thromboembolism: A Meta-analysis of Literature Studies. Semin Thromb Hemost 2020; 46: 763-771
- 3 Zhang L, Feng X, Zhang D. et al. Deep Vein Thrombosis in Hospitalized Patients With COVID- 19 in Wuhan, China: Prevalence, Risk Factors, and Outcome. Circulation 2020; 142 (02) 114-128
- 4 Klok FA, Kruip MJHA, van der Meer NJM. et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thromb Res 2020; 191: 148-150
- 5 Goßlau Y, Warm TD, Hernandez Cancino EF. et al. The prevalence of vascular complications in SARS-CoV-2 infected outpatients. Wien Med Wochenschr 2023; 173: 168-172
- 6 Nopp S, Moik F, Jilma B.. et al. Risk of venous thromboembolism in patients with COVID-19: A systematic review and meta-analysis. Res Pract Thromb Haemost 2020; 4 (07) 1178-1191
- 7 Xie J, Prats-Uribe A, Qi Feng. et al. Clinical and genetic risk factors for acute incident venous Thromboembolism in Ambulatory Patients with Covid-19. JAMA Intern Med 2022; 182 (10) 1063-1070
- 8 Zerwes S, Hernandez Cancino F, Liebetrau D. et al. Erhöhtes Risiko für tiefe Beinvenenthrombosen bei Intensivpatienten mit CoViD-19-Infektion? – Erste Daten. Chirurg 2020; 91 (07) 588-594
- 9 Katsoularis I, Fonseca-Rodríguez O, Farrington P. et al. Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study. BMJ 2022; 377: e069590
- 10 Wells PS. Integrated strategies for the diagnosis of venous thromboembolism. J Thromb Haemost 2007; 5 (Suppl. 01) 41-50
- 11 Linnemann B, Blank W, Doenst T. et al. Diagnostik und Therapie der Venenthrombose und Lungenembolie S2k-Leitlinie AWMF online AWMF Register Nr.065/002 Stand 11.01.2023.
- 12 Linnemann B, Bauersachs R, Grebe M. Venous thromboembolism in patients with COVID-19 (SARS-CoV-2 infection) – a position paper of the German Society of Angiology (DGA). Vasa 2020; 49 (04) 259-263
- 13 Tholin B, Ghanima W, Einvik G. et al. Incidence of thrombotic complications in hospitalised and non-hospitalised patients after COVID-19 diagnosis. Br J Haematol 2021; 194 (03) 542-546
- 14 Lodigiani C, Iapichino G, Carenzo L. et al. Humanitas COVID-19 Task Force. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res 2020; 191: 9-14
- 15 Middeldorp S, Coppens M, van Haaps TF. et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost 2020; 18 (08) 1995-2002
- 16 Llitjos JF, Leclerc M, Chochois C. et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. J Thromb Haemost 2020; 18 (07) 1743-1746
- 17 Demelo-Rodríguez P, Cervilla-Muñoz E, Ordieres-Ortega L. et al. Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels. Thromb Res 2020; 192: 23-26
- 18 Stücker M, Reich-Schupke S. Aktuelle Aspekte der Diagnostik und Therapie der Oberflächenthrombose des Beines. Phlebologie 2018; 47: 329-333
- 19 Shah S, Shah K, Patel SB. et al. Elevated D-Dimer Levels Are Associated With Increased Risk of Mortality in Coronavirus Disease 2019: A Systematic Review and Meta-Analysis. Cardiol Rev 2020; 28 (06) 295-302
- 20 Cui S, Chen S, Li X. et al. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost 2020; 18 (06) 1421-1424
- 21 Guan WJ, Ni ZY, Hu Y. et al. China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020; 382 (18) 1708-1720
- 22 Atalay B, Cesur A, Agirbasli M. Discrepancy between biomarkers of lung injury and 1-year mortality in COVID-19. Eur J Clin Invest 2022; 52 (09) e13827
- 23 Ohlmeier C, Leverkus F, Kloss S. et al. Schätzung der Inzidenz venöser Thromboembolien (VTE) anhand verschiedener Routinedaten des Gesundheitswesens in Deutschland [Estimating the incidence of venous thromboembolism (VTE) using various types of routine data of the German healthcare system]. Z Evid Fortbild Qual Gesundhwes 2018; 139: 46-52
- 24 Ghanima W, Brodin E, Schultze A. et al. Incidence and prevalence of venous thromboembolism in Norway 2010–2017. Thromb Res 2020; 195: 165-168
- 25 Heit JA, Silverstein MD, Mohr DN. et al. The epidemiology of venous thromboembolism in the community. Thromb Haemost 2001; 86 (01) 452-463
- 26 Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis 2016; 41 (01) 3-14
- 27 Fang MC, Reynolds K, Tabada GH. et al. Assessment of the Risk of Venous Thromboembolism in Nonhospitalized Patients With COVID-19. JAMA Network Open 2023; 6 (03) e232338
- 28 Vanassche T, Orlando C, Vandenbosch K.. et al. Belgian clinical guidance on anticoagulation management in hospitalised and ambulatory patients with COVID-19. Acta Clin Belg 2022; 77 (02) 280-285
- 29 Schulman S, Sholzberg M, Spyropoulos AC. et al. International Society on Thrombosis and Haemostasis. ISTH guidelines for antithrombotic treatment in COVID-19. J Thromb Haemost 2022; 20 (10) 2214-2225
- 30 Zerwes S, Steinbauer M, Gosslau Y. et al. COVID-19-Infektion – Risiko für thrombembolische Komplikationen [COVID-19 infection-Risk of thromboembolic complications]. Gefasschirurgie 2020; 25 (06) 397-402
- 31 Bekanntmachungen zum Post-Covid-Syndrom (PCS) der Bundesärztekammer Deutsches Ärzteblatt 14.10.2022. DOI: 3238/arztebl.2022.
- 32 Zuin M, Rigatelli G, Zuliani G. et al. The risk of thrombosis after acute-COVID-19 infection. QJM 2021; 114 (09) 619-620
