{"title":"加拿大艾伯塔省 COVID-19 患者的静脉血栓栓塞流行率和抗凝剂使用情况。","authors":"Lynnea Schultz, Tammy J Bungard, Elizabeth Mackay, Pawandeep Gill, Micheal Guirguis","doi":"10.4212/cjhp.3209","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>COVID-19 causes a hypercoagulable state and increases the risk of venous thromboembolism (VTE).</p><p><strong>Objectives: </strong>The primary objective was to identify VTE prevalence among patients with COVID-19 in one Canadian province. Secondary objectives were to identify the prevalence of bleeding, describe anticoagulation prescribing practices, and identify factors contributing to VTE in these patients.</p><p><strong>Methods: </strong>Adult patients admitted to Alberta hospitals between March and December 2020 with COVID-19 who had a length of stay of at least 72 hours were included in this retrospective study. VTE, bleeding events, and comorbidities were defined by <i>International Classification of Diseases and Related Health Problems, 10th Revision</i> codes. Cases of VTE and controls (no VTE) were matched on the basis of age older than 60 years, active cancer, and length of stay for the full cohort, as well as for a subgroup of patients with d-dimer data available, to assess for factors associated with VTE.</p><p><strong>Results: </strong>A total of 2544 patients were included. Median age was 66 years, 1461 patients (57.4%) were male, median weight was 77.7 kg, and median d-dimer level on admission was 1.00 mg/L. The prevalence of VTE was 3.7% (<i>n</i> = 93) and that of major and clinically relevant non-major bleeding was 4.9% (<i>n</i> = 125). Of the total population, 1224 patients (48.1%) had standard prophylactic-dose anticoagulation, 460 (18.1%) received only higher-dose anticoagulation, 248 (9.7%) received both prophylactic- and higher-dose anticoagulation, and 612 (24.1%) had no anticoagulation data. Logistic regression showed that only the presence of d-dimer above 3 mg/L was associated with a significant odds ratio for VTE (7.04, 95% confidence interval 2.43-20.84).</p><p><strong>Conclusions: </strong>VTE prevalence among patients with COVID-19 was higher than baseline prevalence in Alberta. Analysis of prescribing practices demonstrated that a large proportion of patients received higher-dose anticoagulation.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 4","pages":"286-293"},"PeriodicalIF":0.6000,"publicationDate":"2022-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524556/pdf/cjhp-75-286.pdf","citationCount":"0","resultStr":"{\"title\":\"Prevalence of Venous Thromboembolism and Anticoagulant Use in Patients with COVID-19 in Alberta, Canada.\",\"authors\":\"Lynnea Schultz, Tammy J Bungard, Elizabeth Mackay, Pawandeep Gill, Micheal Guirguis\",\"doi\":\"10.4212/cjhp.3209\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>COVID-19 causes a hypercoagulable state and increases the risk of venous thromboembolism (VTE).</p><p><strong>Objectives: </strong>The primary objective was to identify VTE prevalence among patients with COVID-19 in one Canadian province. Secondary objectives were to identify the prevalence of bleeding, describe anticoagulation prescribing practices, and identify factors contributing to VTE in these patients.</p><p><strong>Methods: </strong>Adult patients admitted to Alberta hospitals between March and December 2020 with COVID-19 who had a length of stay of at least 72 hours were included in this retrospective study. VTE, bleeding events, and comorbidities were defined by <i>International Classification of Diseases and Related Health Problems, 10th Revision</i> codes. Cases of VTE and controls (no VTE) were matched on the basis of age older than 60 years, active cancer, and length of stay for the full cohort, as well as for a subgroup of patients with d-dimer data available, to assess for factors associated with VTE.</p><p><strong>Results: </strong>A total of 2544 patients were included. Median age was 66 years, 1461 patients (57.4%) were male, median weight was 77.7 kg, and median d-dimer level on admission was 1.00 mg/L. The prevalence of VTE was 3.7% (<i>n</i> = 93) and that of major and clinically relevant non-major bleeding was 4.9% (<i>n</i> = 125). Of the total population, 1224 patients (48.1%) had standard prophylactic-dose anticoagulation, 460 (18.1%) received only higher-dose anticoagulation, 248 (9.7%) received both prophylactic- and higher-dose anticoagulation, and 612 (24.1%) had no anticoagulation data. Logistic regression showed that only the presence of d-dimer above 3 mg/L was associated with a significant odds ratio for VTE (7.04, 95% confidence interval 2.43-20.84).</p><p><strong>Conclusions: </strong>VTE prevalence among patients with COVID-19 was higher than baseline prevalence in Alberta. Analysis of prescribing practices demonstrated that a large proportion of patients received higher-dose anticoagulation.</p>\",\"PeriodicalId\":51646,\"journal\":{\"name\":\"CANADIAN JOURNAL OF HOSPITAL PHARMACY\",\"volume\":\"75 4\",\"pages\":\"286-293\"},\"PeriodicalIF\":0.6000,\"publicationDate\":\"2022-10-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524556/pdf/cjhp-75-286.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"CANADIAN JOURNAL OF HOSPITAL PHARMACY\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4212/cjhp.3209\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4212/cjhp.3209","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
Prevalence of Venous Thromboembolism and Anticoagulant Use in Patients with COVID-19 in Alberta, Canada.
Background: COVID-19 causes a hypercoagulable state and increases the risk of venous thromboembolism (VTE).
Objectives: The primary objective was to identify VTE prevalence among patients with COVID-19 in one Canadian province. Secondary objectives were to identify the prevalence of bleeding, describe anticoagulation prescribing practices, and identify factors contributing to VTE in these patients.
Methods: Adult patients admitted to Alberta hospitals between March and December 2020 with COVID-19 who had a length of stay of at least 72 hours were included in this retrospective study. VTE, bleeding events, and comorbidities were defined by International Classification of Diseases and Related Health Problems, 10th Revision codes. Cases of VTE and controls (no VTE) were matched on the basis of age older than 60 years, active cancer, and length of stay for the full cohort, as well as for a subgroup of patients with d-dimer data available, to assess for factors associated with VTE.
Results: A total of 2544 patients were included. Median age was 66 years, 1461 patients (57.4%) were male, median weight was 77.7 kg, and median d-dimer level on admission was 1.00 mg/L. The prevalence of VTE was 3.7% (n = 93) and that of major and clinically relevant non-major bleeding was 4.9% (n = 125). Of the total population, 1224 patients (48.1%) had standard prophylactic-dose anticoagulation, 460 (18.1%) received only higher-dose anticoagulation, 248 (9.7%) received both prophylactic- and higher-dose anticoagulation, and 612 (24.1%) had no anticoagulation data. Logistic regression showed that only the presence of d-dimer above 3 mg/L was associated with a significant odds ratio for VTE (7.04, 95% confidence interval 2.43-20.84).
Conclusions: VTE prevalence among patients with COVID-19 was higher than baseline prevalence in Alberta. Analysis of prescribing practices demonstrated that a large proportion of patients received higher-dose anticoagulation.
期刊介绍：
The CJHP is an academic journal that focuses on how pharmacists in hospitals and other collaborative health care settings optimize safe and effective drug use for patients in Canada and throughout the world. The aim of the CJHP is to be a respected international publication serving as a major venue for dissemination of information related to patient-centred pharmacy practice in hospitals and other collaborative health care settings in Canada and throughout the world.
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