Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy

Abstract

Background: Few data are available on the rate and characteristics of thromboembolic complications in hospitalized patients with COVID-19. Methods: We studied consecutive symptomatic patients with laboratory-proven COVID-19 admitted to a university hospital in Milan, Italy (13.02.2020Italy (13.02. -10.04.2020. The primary outcome was any thromboembolic complication, including venous thromboembolism (VTE), ischemic stroke, and acute coronary syndrome (ACS)/ myocardial infarction (MI). Secondary outcome was overt disseminated intravascular coagulation (DIC). Results: We included 388 patients (median age 66 years, 68% men, 16% requiring intensive care [ICU]). Thromboprophylaxis was used in 100% of ICU patients and 75% of those on the general ward. Thromboembolic events occurred in 28 (7.7% of closed cases; 95%CI 5.4%-11.0%), corresponding to a cumulative rate of 21% (27.6% ICU, 6.6% general ward). Half of the thromboembolic events were diagnosed within 24 h of hospital admission. Forty-four patients underwent VTE imaging tests and VTE was confirmed in 16 (36%). Computed tomography pulmonary angiography (CTPA) was performed in 30 patients, corresponding to 7.7% of total, and pulmonary embolism was confirmed in 10 (33% of CTPA). The rate of ischemic stroke and ACS/MI was 2.5% and 1.1%, respectively. Overt DIC was present in 8 (2.2%) patients. Conclusions: The high number of arterial and, in particular, venous thromboembolic events diagnosed within 24 h of admission and the high rate of positive VTE imaging tests among the few COVID-19 patients tested suggest that there is an urgent need to improve specific VTE diagnostic strategies and investigate the efficacy and safety of thromboprophylaxis in ambulatory COVID-19 patients.

Incidence of venous thromboembolism in hospitalized patients with COVID‐19

“…In an Italian single-center retrospective cohort study, the proportion of COVID-19 patients with VTE was 6% in ward patients, corresponding to a cumulative incidence of 7%. 11 These reported risks appear to be higher than expected in medical hospitalized patients who are not critically ill. 13 Based on the present findings, we believe the threshold of suspicion of VTE in COVID-19 patients should be low and elicit appropriate diagnostic testing and treatment if VTE is diagnosed. The clinical value of ultrasound screening of the lower extremities in ICU patients with COVID-19 is a matter of debate.…”

“…Median follow-up duration was 15 days in ICU patients (IQR, [9][10][11][12][13][14][15][16][17][18][19][20] and 4 days in ward patients (IQR, 2-7).…”

Haematological factors of SARS-CoV-2 infection aggravation: a COVID'HEMOS study

“…ISTH and the American Society of Hematology recommended prophylactic dose of low molecular weight heparin to prevent thrombotic event (47)(48)(49). Even with thromboprophylaxis, 7.7% of patients in academic hospital of Milan developed thrombotic event (50). The association between Padua score>4 and D-dimer>1000 µg/L had a sensitivity of 88.52% and a speci city of 61.43% for screening risk for DVT (51).…”

High Incidence of Venous Thromboembolism in Patients with Coronavirus Disease 2019: A Call for Improved Awareness and Prevention

“…Coronavirus disease 2019 (COVID- 19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has led to a global health crisis. Emerging evidence shows that patients with COVID-19, especially those who are severely ill, have a variety of risk factors for venous thromboembolism (VTE), including infection, immobilization, and mechanical ventilation [1]. The high mortality of COVID-19 patients has been presumed to be partly due to unrecognized pulmonary embolism (PE) and pulmonary in situ thrombosis [2].…”