COVID-19與靜脈血栓栓塞：臨床診斷、預防、和治療

COVID-19 and Venous Thromboembolism: Diagnosis, Prophylaxis, and Treatment

許栢超(Po-Chao Hsu) ； 紀乃宇(Nai-Yu Chi) ； 張景棠(Ching-Tang Chang) ； 林宗憲(Tsung-Hsien Lin) ； 蘇河名(Ho-Ming Su)

《內科學誌》 35卷2期 (2024/04) Pp. 99-105

https://doi.org/10.6314/JIMT.202404_35(2).01

摘要

感染COVID-19（新冠）後患者有較高發生靜脈血栓栓塞的風險。但過往由於文獻資料並不足，因此對於新冠所導致的靜脈血栓栓塞，臨床上該如何診斷治療以及是否需要對於有感染新冠的患者給予預防性抗凝劑很難有較多實證醫學的證據來回答。這些年隨著疫情的進展，有不少臨床試驗都陸續有結果產生。這使得上敘的這些問題開始有了比較明確的一些實證證據。本文將針對這些年國際上的較新文獻資料做整理介紹，希望能讓大家對此議題有更深一層的認知。但也由於亞洲族群有相對較低的靜脈血栓栓塞發生率，對於亞洲族群是否須比照其他西方國家給予預防性抗凝劑這點仍存在爭議，再加上新冠病毒隨著變種及時間進展毒性似乎逐漸減弱。因此，本文的實證資料不一定全然適用於亞洲族群，且會隨著新冠疾病進展而有動態變化調整，在此僅供臨床醫師做為診斷治療上的參考使用。

關鍵字

新冠（COVID-19） ； 靜脈血栓栓塞（Venous thromboembolism） ； 預防（Prophylaxis） ； 凝血障礙（Coagulopathy） ； 抗凝血劑（Anti-coagulant）

並列摘要

Patients infected with COVID-19 have a higher risk of venous thromboembolism (VTE). However, in the past, there was insufficient medical evidence to answer the questions about clinical diagnosis and treatment of COVID-19 associated VTE and whether it is necessary to give prophylactic anticoagulants to patients infected with COVID-19. With the progress of the epidemic in recent years, many clinical trials have provided important results one after another. This makes the above-mentioned issues begin to have some clear empirical evidence. This article summarizes and introduces the newer international literatures in recent years and hope to give physicians a deeper understanding of the issues. However, because the Asian population has a relatively low incidence of VTE, it is still controversial whether the Asian population should be given prophylactic anticoagulants compared with other Western countries. In addition, the toxicity of mutant coronavirus seems to gradually weaken over time. Therefore, the evidence-based medicine in this article may not be fully applicable to the Asian population, and will be adjusted dynamically with the progress of coronavirus.