Tiefe Beinvenenthrombosen bei Intensivpatienten mit COVID-19-Infektion – Einfluss eines standardisierten Therapieregimes

Zusammenfassung

Hintergrund und Fragestellung Die erhöhte Inzidenz tiefer Beinvenenthrombosen (TVT) bei Intensivpatienten mit COVID-19-Infektion ist mehrfach beschrieben worden. Kann das Thromboserisiko bei diesen Patienten durch standardisierte Systemtherapie gesenkt werden?

Material und Methoden Nach Etablierung eines Therapiestandards mit Vollantikoagulation, Gabe von Dexamethason und Rekonvaleszentenplasma wurden 20 Patienten mit COVID-19-Pneumonie auf das Vorliegen einer TVT mittels Kompressionssonografie gescreent. Als Vergleichsgruppe dienten 20 COVID-Infizierte mit noch uneinheitlicher Therapie, die wir während der 1. Erkrankungswelle auf das Vorliegen einer Thrombose untersucht haben.

Ergebnisse In der aktuellen Studienpopulation mit standardisiertem Therapieregime konnten wir keine Thrombose detektieren, wohingegen im COVID-Kollektiv unserer Voruntersuchung 20% der Erkrankten (n=4) eine TVT entwickelten. Lungenembolien traten in beiden Gruppen auf; 1 in der 1., 2 in der 2. Kohorte.

Diskussion Durch Vollantikoagulation, Steroidgabe und Verabreichen von Rekonvaleszentenplasma konnte das TVT-Risiko gesenkt werden. Die dezidierte Bedeutung der einzelnen Komponenten ist nicht geklärt. Da Blutungen bei SARS-CoV-2-Infektion bisher nur selten beobachtet wurden, scheint eine großzügige Indikation zur Antikoagulation gerechtfertigt.

Abstract

Background and Objectives It has been reported that the risk of deep vein thrombosis is greater in patients with COVID-19 infection. We have now investigated whether a standardised therapy can reduce the risk of DVT.

Materials and Methods After establishing standard therapy with anticoagulation, steroids and convalescent plasma, we screened 20 patients with COVID-19 pneumonia for DVT by ultrasound examination. The comparison group contained 20 COVID patients with inconsistent therapy, who were examined for the presence of thrombosis during the first wave.

Results In the current patient population with standard therapy, we could not detect any thrombosis, and in the prior patients group only 25% of patients developed DVT. Pulmonary embolism was found in one patient in the first cohort and two in the second.

Conclusion The risk of DVT could be reduced through anticoagulation, and administration of steroids and convalescent plasma. The specific significance of the individual components has not yet been clarified. Since bleeding is a rarely observed in SARS-CoV-2 infections, a generous indication for anticoagulation seems to be justified.

Schlüsselwörter

COVID-19 - Thrombose - Antikoagulation - Rekonvaleszentenplasma - Steroide

Keywords

COVID-19 - Thrombosis - Anticoagulation - convalescent plasma - steroids

Publikationsverlauf

Eingereicht: 03. Juli 2021

Angenommen nach Revision: 29. August 2021

Artikel online veröffentlicht:
27. Oktober 2021

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