Characteristics of Venous Thromboembolism in COVID-19 Patients: A Multicenter Experience from Northern Italy

Abstract

Background The liability of patients affected by novel coronavirus disease (COVID-19) to develop venous thromboembolic events is widely acknowledged. However, many particulars of the interactions between the two diseases are still unknown. This study aims to outline the main characteristics of deep venous thrombosis (DVT) and pulmonary embolism (PE) in COVID-19 patients, based on the experience of four high-volume COVID-19 hospitals in Northern Italy. Methods All cases of COVID-19 in-hospital patients undergoing duplex ultrasound (DUS) for clinically suspected DVT between March 1st and April 25th, 2020, were reviewed. Demographics and clinical data of all patients with confirmed DVT were recorded. Computed tomography pulmonary angiographies of the same population were also examined looking for signs of PE. Results Of 101 DUS performed, 42 were positive for DVT, 7 for superficial thrombophlebitis, and 24 for PE, 8 of which associated with a DVT. Most had a moderate (43.9%) or mild (16.9%) pneumonia. All venous districts were involved. Time of onset varied greatly, but diagnosis was more frequent in the first two weeks since in-hospital acceptance (73.8%). Most PEs involved the most distal pulmonary vessels, and two-thirds occurred in absence of a recognizable DVT. Conclusions DVT, thrombophlebitis, and PE are different aspects of COVID-19 procoagulant activity and they can arise regardless of severity of respiratory impairment. All venous districts can be involved, including the pulmonary arteries, where the high number and distribution of the thrombotic lesions without signs of DVT could hint a primitive thrombosis rather than embolism.

Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis.

“…After excluding duplicates and preliminary screening, 151 full-text articles were assessed for eligibility and 130 studies were excluded for not meeting the inclusion criteria, leaving 23 investigation fulfilling the inclusion criteria ( Fig. 1) [1,3,4,8,12,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33].…”

“…Although the concomitant comorbidities were not systematically recorded by all investigations, active cancer and previous venous thromboembolic events were reported in a small percentage of cases. Fourteen studies considered ICU patients [1 , 3 , 4 , 8 , [16] , [17] , [18] , [19] , [20] , 22 , 25 , 26 , 28] while fifteen provided data of subjects hospitalized in general wards [1 , 8 , 17 , 20 , 21 , 23 , 24 , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] . Seven studies reported the data of both ICU and general wards patients [1 , 8 , 17 , 19 , 20 , 26 , 28] .…”

“… [26] Retrospective Single center 61.5 214 129 (60.2) NR NR 16 (7) NR 21 (10) X X 7 Marone et al. [27] Retrospective Single center NR 101 NR NR NR NR NR NR X 5 Fauvel et al. [28] Retrospective Multicenter 64 (SD:17) 1240 721 (58) 559 (45) 268 (22) 167 (13.5) 94 (8) 98 (8) X X 8 Van den Heuvel [29] Retrospective Single center 63 [51–68] 51 41 (80) 21 (41) 9 (18) NR 2 (4) NR X 6 Mestre-Gomez et al.…”

COVID-19 Infection: Viral Macro- and Micro-Vascular Coagulopathy and Thromboembolism/Prophylactic and Therapeutic Management

“…Another study of 101 COVID-19 in-hospital patients undergoing duplex ultrasound (DUS) for clinically suspected DVT indicated that 42 were positive for DVT, 7 for superficial thrombophlebitis and 24 for PE, 8 of which associated with a DVT. 22 Time of onset varied greatly, but diagnosis was more frequent in the first 2 weeks since hospital admission (73.8%). Most PEs involved the most distal pulmonary vessels, and two thirds occurred in absence of a recognizable DVT, suggesting a primary thrombosis rather than embolism.…”

“…Most PEs involved the most distal pulmonary vessels, and two thirds occurred in absence of a recognizable DVT, suggesting a primary thrombosis rather than embolism. 22 A single-center review of 214 CTPA studies in 1477 patients with suspected or confirmed COVID-19 indicated that the diagnostic yield for PE was 37%. 23 The overall proportion of PE in patients with COVID-19 was 5.4%.…”