高龄老年新型冠状病毒肺炎患者应用抗凝治疗的短期疗效和安全性

doi:10.6040/j.issn.1671-7554.0.2024.0806

摘要/Abstract

摘要： 目的探讨高龄老年新型冠状病毒肺炎患者接受抗凝治疗的短期疗效和安全性。方法纳入2022年12月-2023年8月在山东大学齐鲁医院因新型冠状病毒肺炎入院且年龄≥80岁的患者,根据是否接受抗凝治疗分为抗凝组和非抗凝组,观察两组患者住院期间出血事件及临床结局。结果共纳入254例患者,平均年龄85岁,其中抗凝组183例、非抗凝组71例。与非抗凝组相比,抗凝组重症(45.90% vs. 30.99%, P<0.001)和危重症(16.39% vs. 4.22%, P<0.001)患者占比更高,二元Logistic分析表明抗凝治疗(OR=9.224, 95%CI: 3.435~24.769)、应用非甾体类抗炎药(OR=3.619, 95%CI:1.696~7.723)为住院期间发生出血事件的独立危险因素。死亡患者33例,其中病情分型为危重型者32例(96.97%)。采用倾向性评分匹配法(propensity score matching, PSM)对两组基线特征特别是病情分型进行均衡后,抗凝组住院期间出血事件发生率显著高于非抗凝组(40.85% vs. 8.45%, P<0.001),两组住院期间死亡率差异无统计学意义(4.22% vs. 4.22%, P>0.999)。结论抗凝治疗未能降低高龄老年新型冠状病毒肺炎患者短期死亡风险,但会增加患者的出血风险。

关键词: 高龄老年, 新型冠状病毒肺炎, 抗凝治疗, 出血, 死亡率, 倾向性评分匹配

Abstract: Objective To analyse short-term efficacy and safety of anticoagulant therapy in elderly patients with corona virus disease 2019. Methods The study included corona virus disease 2019 patients aged ≥ 80 years who were admitted to Qilu Hospital of Shandong University between December 2022 and August 2023. They were divided into anticoagulant and non-anticoagulant groups according to whether they received anticoagulant therapy. The bleeding events and clinical outcomes during hospitalisation were observed in the two groups. Results A total of 254 patients with an average age of 85 years were divided into the anticoagulant group(n=183)and the non-anticoagulant group(n=71). Compared with the non-anticoagulant group, there were more severe(45.90% vs. 30.99%, P<0.001)and critically ill(16.39% vs. 4.22%, P<0.001)patients in the anticoagulant group. Binary Logistic analysis showed that anticoagulant therapy(OR=9.224, 95%CI: 3.435-24.769)and non-steroidal anti-inflammatory drugs(OR=3.619, 95%CI: 1.696-7.723)were independent risk factors for bleeding events during hospitalisation. There were 33 deaths, of which, 32(96.97%)patients were classified as critically ill. After propensity score matching(PSM)to balance baseline characteristics, the incidence of bleeding events in the anticoagulant group was significantly higher than that in the non-anticoagulant group(40.85% vs. 8.45%, P<0.001). There was no significant difference in in-hospital mortality between the two groups(4.22% vs. 4.22%, P>0.999). Conclusion Anticoagulant therapy does not reduce mortality in elderly patients with corona virus disease 2019 but result in more bleeding events.

Key words: Elderly, Corona virus disease 2019, Anticoagulant therapy, Bleeding, Mortality, Propensity score matching

中图分类号:

R563.1

王玉淼,崔晓霈,张红雨. 高龄老年新型冠状病毒肺炎患者应用抗凝治疗的短期疗效和安全性[J]. 山东大学学报 (医学版), 2024, 62(12): 21-31.

WANG Yumiao, CUI Xiaopei, ZHANG Hongyu. Short-term efficacy and safety of anticoagulant therapy in elderly patients with corona virus disease 2019[J]. Journal of Shandong University (Health Sciences), 2024, 62(12): 21-31.

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