Incidence, risk factors, clinical characteristics and outcomes of deep venous Thrombosis in patients with COVID-19 attending the emergency department: Results of the UMC-19-S8

Abstract

on behalf of the Spanish Investigators on Emergency Situations TeAm (SIESTA) network** Background and importance A higher incidence of venous thromboembolism [both pulmonary embolism and deep vein thrombosis (DVT)] in patients with coronavirus disease 2019 (COVID-19) has been described. But little is known about the true frequency of DVT in patients who attend emergency department (ED) and are diagnosed with COVID-19.Objective We investigated the incidence, risk factors, clinical characteristics and outcomes of DVT in patients with COVID-19 attending the ED before hospitalization. MethodsWe retrospectively reviewed all COVID patients diagnosed with DVT in 62 Spanish EDs (20% of Spanish EDs, case group) during the first 2 months of the COVID-19 outbreak. We compared DVT-COVID-19 patients with COVID-19 without DVT patients (control group). Relative frequencies of DVT were estimated in COVID and non-COVID patients visiting the ED and annual standardized incidences were estimated for both populations. Sixty-three patient characteristics and four outcomes were compared between cases and controls. ResultsWe identified 112 DVT in 74 814 patients with COVID-19 attending the ED [1.50‰; 95% confidence interval (CI), 1.23-1.80‰]. This relative frequency was similar than that observed in non-COVID patients [2109/1 388 879; 1.52‰; 95% CI, 1.45-1.69‰; odds ratio (OR) = 0.98 [0.82-1.19]. Standardized incidence of DVT was higher in COVID patients (98,38 versus 42,93/100,000/ year; OR, 2.20; 95% CI, 2.03-2.38). In COVID patients, the clinical characteristics associated with a higher risk of presenting DVT were older age and having a history of venous thromboembolism, recent surgery/immobilization and hypertension; chest pain and desaturation at ED arrival and some analytical disturbances were also more frequently seen, d-dimer >5000 ng/mL being the strongest. After adjustment for age and sex, hospitalization, ICU admission and prolonged hospitalization were more frequent in cases than controls, whereas mortality was similar (OR, 1.37; 95% CI, 0.77-2.45).Conclusions DVT was an unusual form of COVID presentation in COVID patients but was associated with a worse prognosis.

Deep Vein Thrombosis : An Unusual Presentation in COVID-19 Patients-Our Experience and Comparison with Non COVID-19 Deep Vein Thrombosis Cases

“…10 In one study DVT as the presenting feature of COVID-19 was found to be 1.5% and was associated with worse prognosis. 11 Infection induced inflammatory changes have been considered as cause of VTE. 11,12,13 So, the aim of the study is to know the proportion of cases of DVT with concomitant COVID-19.…”

“…11 Infection induced inflammatory changes have been considered as cause of VTE. 11,12,13 So, the aim of the study is to know the proportion of cases of DVT with concomitant COVID-19. The study also aims to know any major differences between DVT patients with and without COVID-19 status.…”

Contributions of the Spanish Investigators in the Emergency Situations TeAm network to COVID-19 knowledge: an example of how emergency physicians can lead first-class research

“…In fact, the SIESTA network has provided one of the largest series published worldwide for some entities. This incentivized top journals of many specialties [14–17] as well, obviously, as the leading journals in the field of emergency medicine [18,19] to published research led by emergency medicine physicians.…”