Thromboinflammatory state and venous thromboembolic events in patients with coronavirus disease 2019 admitted to a non-intensive care ward: a prospective study

Fortini, Alberto; Beltrame, Chiara; Faraone, Antonio; Iandelli, Serena; Zaccagnini, Giacomo; Forte, Aldo Lo

doi:10.20452/pamw.15625

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…In the acute phase of COVID-19, the presence of a thromboinflammatory state, characterized by high levels of inflammatory parameters, such as CRP, ferritin and Interleukin-6, and some coagulation indices, such as fibrinogen and D-dimer, has been described [ 27 , 28 ]. These changes were associated with a high frequency of venous thromboembolic complications.…”

Section: Discussionmentioning

confidence: 99%

COVID-19: persistence of symptoms and lung alterations after 3–6 months from hospital discharge

et al. 2021

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Purpose Few data are currently available on persistent symptoms and late organ damage in patients who have suffered from COVID-19. This prospective study aimed to evaluate the results of a follow-up program for patients discharged from a nonintensive COVID-19 ward. Methods 3–6 months after hospital discharge, 59 of 105 COVID-19 patients (31 males, aged 68.2 ± 12.8 years) were recruited in the study. Forty-six patients were excluded because of nontraceability, refusal, or inability to provide informed consent. The follow-up consisted of anamnesis (including a structured questionnaire), physical examination, blood tests, ECG, lower limb compression venous ultrasound (US), thoracic US, and spirometry with diffusion lung capacity for carbon monoxide (DLCO). Results 22% of patients reported no residual symptoms, 28.8% 1 or 2 symptoms and 49.2% 3 or more symptoms. The most frequently symptoms were fatigue, exertional dyspnea, insomnia, and anxiety. Among the inflammatory and coagulation parameters, only the median value of fibrinogen was slightly above normal. A deep vein thrombosis was detected in 1 patient (1.7%). Thoracic US detected mild pulmonary changes in 15 patients (25.4%), 10 of which reported exertional dyspnea. DLCO was mildly or moderately reduced in 19 patients (37.2%), 13 of which complained of exertional dyspnea. Conclusion These results highlight that a substantial percentage of COVID-19 patients (77.8%) continue to complain of symptoms 3–6 months after hospital discharge. Exertional dyspnea was significantly associated with the persistence of lung US abnormalities and diffusing capacity alterations. Extended follow-up is required to assess the long-term evolution of postacute sequelae of COVID-19.

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Section: Discussionmentioning

confidence: 99%

COVID-19: persistence of symptoms and lung alterations after 3–6 months from hospital discharge

et al. 2021

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“…Along with the documentation of coagulopathy, an increased incidence of venous thromboembolism (VTE) has been reported in patients hospitalized for COVID-19 pneumonia with respect to "usual" infectious respiratory disease. Actually, the incidence of VTE in non-ICU patients admitted for infectious respiratory disease is estimated around 5%, with adequate thromboprophylaxis, while the incidence in COVID-19 patients has been reported as high as 20% [4][5][6][7][8][9][10][11]. In the SARS-CoV-2 pandemic scenario, the most reliable data derive from studies carried out in ICU patients, while less robust information is available for patients with COVID-19 pneumonia admitted to non-ICU settings, such as those of Pneumology and Internal Medicine Units (IMUs).…”

Section: Introductionmentioning

confidence: 99%

Incidence of deep vein thrombosis through an ultrasound surveillance protocol in patients with COVID-19 pneumonia in non-ICU setting: A multicenter prospective study

et al. 2021

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Objective The aim of this study was to assess the incidence of deep vein thrombosis (DVT) of the lower limbs, using serial compression ultrasound (CUS) surveillance, in acutely ill patients with COVID-19 pneumonia admitted to a non-ICU setting. Methods Multicenter, prospective study of patients with COVID-19 pneumonia admitted to Internal Medicine units. All patients were screened for DVT of the lower limbs with serial CUS. Anticoagulation was defined as: low dose (enoxaparin 20–40 mg/day or fondaparinux 1.5–2.5 mg/day); intermediate dose (enoxaparin 60–80 mg/day); high dose (enoxaparin 120–160 mg or fondaparinux 5–10 mg/day or oral anticoagulation). The primary end-point of the study was the diagnosis of DVT by CUS. Results Over a two-month period, 227 consecutive patients with moderate-severe COVID-19 pneumonia were enrolled. The incidence of DVT was 13.7% (6.2% proximal, 7.5% distal), mostly asymptomatic. All patients received anticoagulation (enoxaparin 95.6%) at the following doses: low 57.3%, intermediate 22.9%, high 19.8%. Patients with and without DVT had similar characteristics, and no difference in anticoagulant regimen was observed. DVT patients were older (mean 77±9.6 vs 71±13.1 years; p = 0.042) and had higher peak D-dimer levels (5403 vs 1723 ng/mL; p = 0.004). At ROC analysis peak D-dimer level >2000 ng/mL (AUC 0.703; 95% CI 0.572–0.834; p = 0.004) was the most accurate cut-off value able to predict DVT (RR 3.74; 95%CI 1.27–10, p = 0.016). Conclusions The incidence of DVT in acutely ill patients with COVID-19 pneumonia is relevant. A surveillance protocol by serial CUS of the lower limbs is useful to timely identify DVT that would go otherwise largely undetected.

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“…Specifically, a high incidence of venous thromboembolism (VTE) has been reported in patients hospitalized for COVID-19 pneumonia. Indeed, the incidence of VTE in patients hospitalized for COVID-19 pneumonia in a non-ICU setting has been reported up to 20% [3][4][5][6][7][8]. In a recent large multicenter prospective study in non-ICU patients with moderate-severe COVID-19, we reported an incidence of deep vein thrombosis (DVT) of the lower limbs, using serial compression ultrasound (CUS) surveillance of 13.7% [9] during the first Italian wave of pandemic.…”

Section: Introductionmentioning

confidence: 99%

Incidence of lower limb deep vein thrombosis in patients with COVID-19 pneumonia through different waves of SARS-CoV-2 pandemic: A multicenter prospective study

et al. 2023

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Objective The aim of this study was to evaluate the incidence of deep vein thrombosis (DVT) of the lower limbs in patients hospitalized with COVID-19 pneumonia in a non-ICU setting according to the different waves of the SARS-CoV-2 pandemic. Methods Multicenter, prospective study of patients with COVID-19 pneumonia admitted to Internal Medicine units in Italy during the first (March-May 2020) and subsequent waves (November 2020 –April 2021) of the pandemic using a serial compression ultrasound (CUS) surveillance to detect DVT of the lower limbs. Results Three-hundred-sixty-three consecutive patients were enrolled. The pooled incidence of DVT was 8%: 13.5% in the first wave, and 4.2% in the subsequent waves (p = 0.002). The proportion of patients with early (< 4 days) detection of DVT was higher in patients during the first wave with respect to those of subsequent waves (8.1% vs 1.9%; p = 0.004). Patients enrolled in different waves had similar clinical characteristics, and thrombotic risk profile. Less patients during the first wave received intermediate/high dose anticoagulation with respect to those of the subsequent waves (40.5% vs 54.5%; p = 0.005); there was a significant difference in anticoagulant regimen and initiation of thromboprophylaxis at home (8.1% vs 25.1%; p<0.001). Conclusions In acutely ill patients with COVID-19 pneumonia, the incidence of DVT of the lower limbs showed a 3-fold decrease during the first with respect to the subsequent waves of the pandemic. A significant increase in thromboprophylaxis initiation prior to hospitalization, and the increase of the intensity of anticoagulation during hospitalization, likely, played a relevant role to explain this observation.

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Thromboinflammatory state and venous thromboembolic events in patients with coronavirus disease 2019 admitted to a non-intensive care ward: a prospective study

Cited by 5 publications

References 12 publications

COVID-19: persistence of symptoms and lung alterations after 3–6 months from hospital discharge

COVID-19: persistence of symptoms and lung alterations after 3–6 months from hospital discharge

Incidence of deep vein thrombosis through an ultrasound surveillance protocol in patients with COVID-19 pneumonia in non-ICU setting: A multicenter prospective study

Incidence of lower limb deep vein thrombosis in patients with COVID-19 pneumonia through different waves of SARS-CoV-2 pandemic: A multicenter prospective study

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