Venous thromboembolism and COVID-19: a single center experience from an academic tertiary referral hospital of Northern Italy

Abstract

Preliminary evidence supports the notion that COVID-19 patients may have an increased susceptibility to develop venous thromboembolism (VTE). However, the magnitude of this association still needs to be defined. Furthermore, clinical predictors of thrombogenesis, and the relationship with the inflammatory status are currently unknown. On this basis, we conducted a retrospective, observational study on 259 consecutive COVID-19 patients admitted to an academic tertiary referral hospital in Northern Italy between March 19th and April 6th, 2020. Records of COVID-19 patients with a definite VTE event were reviewed for demographic information, co-morbidities, risk factors for VTE, laboratory tests, and anticoagulation treatment. Twenty-five cases among 259 COVID-19 patients developed VTE (9.6%), all of them having a Padua score > 4, although being under standard anticoagulation prophylaxis since hospital admission. In the VTE subcohort, we found a significant positive correlation between platelet count (PLT) and either C reactive protein (CRP) (p < 0.0001) or lactate dehydrogenase (LDH) (p = 0.0013), while a significant inverse correlation was observed between PLT and mean platelet volume (p < 0.0001). Platelet-to-lymphocyte ratio significantly correlated with CRP (p < 0.0001). The majority of VTE patients was male and younger compared to non-VTE patients (p = 0.002 and p = 0.005, respectively). No significant difference was found in d-dimer levels between VTE and non VTE patients, while significantly higher levels of LDH (p = 0.04) and IL-6 (p = 0.04) were observed in VTE patients in comparison to non-VTE patients. In conclusion, our findings showed a quite high prevalence of VTE in COVID-19 patients. Raised inflammatory indexes and increased serum levels of pro-inflammatory cytokines should raise the clinical suspicion of VTE.

A simple scoring system in COVID-19 patients with neurological manifestations

“…Consistent with our study, Melazzini et al did not detect an increase in thrombocyte count in patients with venous thrombosis detected by imaging methods. 21 Another neurological manifestation evaluated in our study was epileptic seizures. We found a significant decrease in platelet count in patients with seizures, but we could not detect a substantial increase in MPV.…”

Predictive scores for the diagnosis of Pulmonary Embolism in COVID-19: A systematic review

“…Our search retrieved 158 articles of which 12 were eventually included (Whyte et al, 2020;Baccellieri et al, 2020;Monfardini et al, 2020;Zotzmann et al, 2020;Kirsch et al, 2020;Melazzini et al, 2020;García-Ortega et al, 2021;Fang et al, 2020;Scardapane et al, 2021;Polo Friz et al, 2021;Kampouri et al, 2020;Caro-Codón et al, 2021), comprising 4526 HCPs. Figure 1 shows the selection process of studies included in the systematic review.…”

“…Regarding other scores utilized in studies included in our review, the usefulness of PPS in predicting PE in HCPs was evaluated in two studies (Baccellieri et al, 2020;Melazzini et al, 2020). The PPS has been validated before COVID-19 to identify the need for anticoagulation in hospitalized patients based on their risk of VTE (Barbar et al, 2010).…”

“…Melazzini et al confirmed similar findings in a retrospective cohort study involving 259 COVID-19 patients (median age 70 years, 68% males); in this study, no patient with PE had a PPS below 4. Nevertherless, it is worth mentioning that only 4 patients in the examined cohort were diagnosed with PE (Melazzini et al, 2020). Scardapane et al reported the ability of the revised Geneva score in predicting PE in a retrospective cohort with 43 COVID-19 patients, all undergoing CTPA as inclusion criteria.…”

Contribution of COVID-19 to the Total Cases of Pulmonary Embolism and the Potential Risk Factors: Single Academic Hospital Study

“…In a study performed in our institution in 2011, females were at more risk of PE than their male counterparts with a ratio of 2:1, and that comes in line with the international trends [ 11 , 12 ]. However, when it comes to VTE events in COVID-19 patients, published reports show that the male gender predominates [ 13 , 14 ]. Our results match with prior publications [ 13 , 14 ].…”