Tiền điều trị bằng thuốc chống đông đường uống có liên quan đến kết quả điều trị tốt hơn ở một nhóm lớn bệnh nhân COVID-19 đa quốc gia có bệnh lý tim mạch đi kèm

Clinical Research in Cardiology - Tập 111 Số 3 - Trang 322-332 - 2022
Marina Rieder1, Nadine Gauchel1, Klaus Kaier2, Carolin Jakob3, Stefan Borgmann4, Annika Y. Claßen3, Ján Schneider5, Lukas Eberwein6, Martin Lablans7, Maria Madeleine Rüthrich8, Sebastian Dolff9, Kai Wille10, Martina Haselberger11, Hanno Heuzeroth12, Christoph Bode13, Constantin von zur Mühlen13, Siegbert Rieg14, Daniel Duerschmied13
1Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
2Institute of Medical Biometry and Statistics, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
3Department I for Internal Medicine, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
4Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany
5School of Medicine, Technical University of Munich, University Hospital Rechts der Isar, Munich, Germany
64Th Department of Internal Medicine, Klinikum Leverkusen, Leverkusen, Germany
7Federated Information Systems, German Cancer Research Center, Heidelberg, Germany
8Department for Internal Medicine II, Hematology and Medical Oncology, University Hospital Jena, Jena, Germany
9Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Duisburg, Germany
10University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Medical Center Minden, University of Bochum, Bochum, Germany
11Department of Medicine I, Passau Municipal Hospital, Passau, Germany
12Department of Emergency and Intensive Care Medicine, Klinikum Ernst-Von-Bergmann, Potsdam, Germany
13Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
14Division of Infectious Diseases, Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany

Tóm tắt

Tóm tắtMục tiêuCác rối loạn đông máu và tắc mạch ven có thể gặp phổ biến trong bệnh coronavirus 2019 (COVID-19) và có liên quan đến kết quả điều trị kém. Việc bắt đầu điều trị chống đông kịp thời sau khi nhập viện đã được chứng minh là có lợi. Trong nghiên cứu này, chúng tôi nhằm xem xét mối liên hệ giữa việc sử dụng thuốc chống đông đường uống (OAC) trước đó với kết quả điều trị ở một nhóm bệnh nhân nhiễm SARS-CoV-2.Phương pháp và kết quảChúng tôi đã phân tích dữ liệu từ cuộc khảo sát lớn đa quốc gia LEOSS (Lean European Open Survey on SARS-CoV-2) từ tháng 3 đến tháng 8 năm 2020. Các bệnh nhân nhiễm SARS-CoV-2 đủ điều kiện được đưa vào nghiên cứu. Chúng tôi đã phân tích hồi cứu mối liên quan giữa việc sử dụng OAC trước đó với tỷ lệ tử vong tổng hợp. Các chỉ số kết quả thứ cấp bao gồm tỷ lệ tử vong liên quan đến COVID-19, phục hồi và các mục tiêu kết hợp giữa tử vong và/hoặc sự kiện huyết khối và tử vong và/hoặc sự kiện chảy máu. Chúng tôi đã giới hạn các sự kiện chảy máu chỉ ở hiện tượng chảy máu trong não để đảm bảo tính liên quan lâm sàng và giảm thiểu lỗi báo cáo. Tổng cộng có 1.433 bệnh nhân nhiễm SARS-CoV-2 đã được phân tích, trong đó 334 bệnh nhân (23,3%) đã dùng OAC trước đó và 1.099 bệnh nhân (79,7%) không sử dụng OAC. Sau khi điều chỉnh rủi ro cho các bệnh lý đi kèm, OAC trước đó cho thấy có ảnh hưởng bảo vệ lên chỉ số tử vong (OR 0,62,P = 0.013) cũng như các chỉ số thứ cấp liên quan đến tử vong là COVID-19 (OR 0,64,P = 0.023) và không phục hồi (OR 0,66,P = 0.014). Chỉ số kết hợp giữa tử vong hoặc sự kiện huyết khối có xu hướng ít xảy ra hơn ở những bệnh nhân sử dụng OAC (OR 0,71,P = 0.056).Kết luậnOAC trước đó có tác dụng bảo vệ ở bệnh nhân COVID-19, không phụ thuộc vào chế độ chống đông trong suốt thời gian nằm viện và độc lập với giai đoạn và diễn biến của bệnh.Tóm tắt đồ họa

Từ khóa


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Clinical Research in Cardiology

Tập 111 Số 3

322-332

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