COVID-19 has sparked a global health crisis in which about millions of people have died. Patients have symptoms ranging from mild to severe, with the most common symptom being pneumonia with acute respiratory distress syndrome. Recently, reports of cardiovascular complications have been increasing. Studies have shown that contracting COVID-19 increases the risk of thrombosis, but it is unclear how long this risk will last and whether COVID-19 also increases the risk of major bleeding.
Recently, research institutions from Sweden and other countries published a report entitled "Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and The results of the matched cohort study (Figure 1) show that patients have a significantly increased risk of deep vein thrombosis, pulmonary embolism, and bleeding within a few months of contracting COVID-19, even in mild patients.
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Figure 1 Research results (Source: BMJ)
To analyze the risk of deep vein thrombosis, pulmonary embolism, and bleeding (e.g., gastrointestinal bleeding or bursting blood vessels in the brain) after COVID-19 infection, Swedish researchers selected data from a national database on more than 1 million people diagnosed with COVID-19 infection between February 1, 2020 and May 25, 2021, and compared them with data from more than 4 million uninfected people (in the control group) during the same period. The incidence ratio and corresponding 95% confidence interval for the first DVT, pulmonary embolism, or bleeding event were determined by using self-controlled case series (Figure 2) and Poisson regression.
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Figure 2 Design of a self-controlled case series (Source: BMJ)
The results of the study show the following:
1. Deep vein thrombosis
During the study period, 1761 participants had their first DEEP VEIN thrombosis event; 783 were women (44.5%) and 978 were men (55.5%). Compared with the control group, the incidence ratio of the first deep vein thrombosis was 5.59 (95% confidence interval: 4.47-6.98) in the first week after infection with COVID-19 and 7.44 (95% confidence interval: 6.06-9.14) in the second week (Table 1). The incidence of DVT within 1-90 days of COVID-19 infection usually increases with age. No effect of sex on DEEP VEIN thrombosis has been found. Patients with more severe COVID-19 appear to have an increased risk of deep vein thrombosis.
2. Pulmonary embolism
During the study period, 3267 participants experienced their first pulmonary embolism. Compared with the control group, the incidence ratio of first pulmonary embolism was 36.17 (95% confidence interval: 31.55-41.47) in the first week after infection with COVID-19 and 46.40 (95% confidence interval: 40.61-53.02) in the second week (Table 1). In the first three months after COVID-19 infection, the incidence was higher among male participants than among female participants, especially in the 50-70 age group. The risk of pulmonary embolism increased among participants with more severe COVID-19 conditions.
3. Bleeding
During the study period, 7927 participants experienced their first bleeding event. Compared with the control group, the incidence ratio of the first bleeding event was 3.46 (95% confidence interval: 3.09-3.87) in the first week after infection with COVID-19 and 2.75 (95% confidence interval: 2.42-3.13) in the second week (Table 1). In the first two months after COVID-19 infection, the incidence was higher among male participants than in female participants, and the incidence of bleeding increased with age. No increase in the risk of bleeding was found in patients with mild disease.
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Table source: BMJ
Whether using statistical methods of self-controlled case series or matched cohort studies, a continued increase in risk was observed. Compared with the control group, the risk of deep vein thrombosis within 3 months of COVID-19 infection, pulmonary embolism within 6 months, and major bleeding within 2 months was higher than that in the control group.
In addition, after adjusting for the effects of a range of potential confounding factors, the researchers found that patients had a 5-fold increased risk of developing deep vein thrombosis, a 33-fold increased risk of developing pulmonary embolism, and a nearly 2-fold increased risk of general bleeding events within 30 days of contracting COVID-19. The more severe the symptoms of COVID-19 infection, the higher the risk of the above. If a COVID-19 patient has an underlying disease or is infected in the first wave of an outbreak in Sweden, the risk is also higher than that of COVID-19 patients who are infected in the second and third waves later. The researchers say the reason for the lower risk is increased vaccination coverage and increased COVID-19 treatment. Even in mild, unpatient COVID-19 patients, the researchers found a 3-fold increased risk of deep vein thrombosis, a 7-fold increased risk of pulmonary embolism, and no increased risk of bleeding.
It can be seen that COVID-19 is a risk factor for deep vein thrombosis, pulmonary embolism and bleeding. The researchers say our findings will influence diagnostic and prevention strategies for thromboembolism after COVID-19 infection. Especially for some middle-aged and elderly people with cardiovascular and cerebrovascular diseases, it should be paid more attention to to strengthen the vaccination of COVID-19!
Vaccination is effective in reducing the risk of pulmonary embolism
After infection with COVID-19, the risk of pulmonary embolism in hospitalized patients and intensive care unit patients within six months was 140 times and 290 times that of the control group, respectively, while the risk of pulmonary embolism in mild patients was 7 times that of the control group, which was much higher than the incidence of thrombosis after vaccination.
Anne-MarieFors Connolly, corresponding author of the article, said: "This is a very good reason to get vaccinated for unvaccinated people – because the risk of thrombosis after COVID-19 infection is much higher than the risk of vaccination. ”
For this study, Frederick K Ho, a lecturer in public health at the University of Glasgow, commented that although many Western countries have further relaxed epidemic prevention and control measures in recent days, this latest study also reminds people of the need to be vigilant about minor COVID-19 infections and related complications, including thromboembolism!
The article researchers further point out that this study supports the use of anticoagulants to stop thrombosis in high-risk patients and emphasizes the importance of vaccination. Vaccines are very effective against severe COVID-19, but have less protective effect against infection, especially the Omikeron variant. While the Omiljung variant virus has severely affected the ability of existing vaccines to avoid infection, there is no doubt about the ability to avoid severe illness. Vaccinating logically reduces the overall risk by preventing infection and reducing the severity of infection when it occurs.
Academician Zhong Nanshan suggested that the vaccine be administered sequentially
"Strengthening immunization is imperative." On the afternoon of April 8, Academician Zhong Nanshan gave a remote lecture for Nankai University with the theme of "Scientific Guidance to Fight the Epidemic, Courageously Climbing the Peak of Medicine" (Figure 3), and made the latest research and judgment on the current epidemic situation. The currently circulating Aomikejung strain has mild symptoms and a relatively low mortality rate compared to Delta virus, for which some countries promote coexistence with the virus.
At the same time, he also mentioned that in the struggle between people and the virus, the highest human right is human life, is healthy life. Speaking of the prevention and control of the new crown pneumonia epidemic, Academician Zhong Nanshan said, "The key issue in the prevention and control of the new crown epidemic is to minimize the transmission and case fatality rate. ”
In this regard, Academician Zhong Nanshan said in conjunction with the epidemic situation in Hong Kong and Shanghai that although the mortality rate of Omicron is low, it has strong transmission power, and if it occurs on a large scale, many lives will be lost. "So for now, full opening up in China is not applicable." For China, it should still insist on dynamic zeroing. ”
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Figure 3 Academician Zhong Nanshan remote teaching screen sharing (Source: [2])
For vaccination, Academician Zhong Nanshan introduced that through the analysis of the immunogenicity of the vaccine in the laboratory, after two doses of inactivated vaccine, a xenophage vaccine was used, and its serum neutralizing antibody level and specific CD4+ activity were higher than those of three doses of inactivated vaccine. "According to this situation, my own third injection is Zhifei's recombinant protein new crown vaccine." Zhong Nanshan suggested that according to the mainland's "dynamic clearance" strategy of not only reducing severe illness and mortality, but also reducing infection rates, it is recommended to use xenophragm vaccines as a sequential vaccination.
Adhere to the "dynamic zero clearance" policy
The continent is vast, the population is large, the age structure is aging, and the vaccination rate of the third dose is obviously insufficient. Data from Hong Kong show that the mortality rate of patients infected with Omilkerong is still more than 0.6%, mainly distributed among the elderly and vaccinated populations. As of 17 March 2022, 34% of the elderly aged 70-79 and 63% of the elderly over the age of 80 in Hong Kong still have not completed two doses of vaccination, only 30% of the 70-79-year-olds and 10% of the elderly over the age of 80 have received the third dose, which is also the reason for the high mortality rate of Omilon infection in Hong Kong.
Based on the domestic population structure and the low vaccination rate of the third dose of the population, the "dynamic clearance" policy can avoid millions of epidemic-related infections and deaths, protect the health of Chinese citizens to the greatest extent, and reflect the basic people-oriented policy of the mainland.
At present, there is no best way to end the new crown epidemic, and it is necessary to actively prevent and control and adhere to the "dynamic clearance". Many experts believe that Aomi Kerong is not a large flu, "dynamic clearance" is the real people-oriented, is an inevitable choice based on national conditions, and is also the best solution for human health at this stage.
According to the official website of the Bureau of Disease Control and Prevention, as of April 14, 2022, 31 provinces (autonomous regions and municipalities directly under the Central Government) and the Xinjiang Production and Construction Corps have reported a total of 3,308.616 million doses of covid-19 vaccine. From a large number of data, the new crown vaccine is still effective against the Olmikejun strain, even if the effectiveness of the vaccine in preventing infection has decreased, but it still has good protection against severe diseases, and the immunity of the Aumikejun strain after vaccination has also been greatly improved.
Therefore, we strongly urge the general public, especially the elderly, to complete vaccination in a timely manner, pay attention to prevention, develop good personal hygiene habits, and cooperate with the government's epidemic prevention measures. The people of the whole country work together and unite as one, and we will eventually defeat the new crown virus!
Resources:
[1] Katsoularis I, Fonseca-Rodríguez O, Farrington P, et al. Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study. BMJ. 2022 Apr6;377:e069590. doi: 10.1136/bmj-2021-069590. PMID: 35387772; PMCID: PMC8984137.
[2] Academician Zhong Nanshan sent a message to Nankai Students: Happy to meet the prosperous world, when not to live up to the prosperity
https://baijiahao.baidu.com/s?id=1729616553367827753&wfr=spider&for=pc
[3] Zhong Nanshan: Covid-19 mortality rate is close to influenza? From a global perspective, it doesn't hold up
https://m.weibo.cn/status/4756441392745777?wm=3333_2001&from=10AC393010&sourcetype=weixin#&video
[4] Why adhere to the "dynamic zeroing"? The reasons behind these 4 points uncover the truth
https://page.om.qq.com/page/OZ8Hy6heyljQzmOPVx4Enieg0
Source: Bio Exploration