Venous thromboembolism frequency in patients hospitalized for SARS-CoV-2 infection

Abstract

Background SARS-CoV-2 infection was associated with a higher thrombotic risk, partially explained by intense systemic inflammatory reaction, longer hospitalizations and intubations as well as central catheters and extracorporeal membrane oxygenation devices. Intrinsic thrombotic potential is questioned as certain patients had plasma lupus anticoagulant (LAC). Purpose This study aimed to evaluate the frequency of venous thromboembolism (VTE) among adult patients hospitalized for COVID-19. Methods This is a retrospective analysis of consecutively hospitalized adult patients with SARS-CoV-2 infection (positive rtPCR) admitted to the University Hospital of Strasbourg from the 25th Feb, 2020 to the 1st Apr, 2020. Patients hospitalized for less than 24 h were excluded and the observation period ended at hospital discharge. Results During the study period, 943 COVID-19 patients were hospitalized in our institution, of whom 772 were included in this analysis. The median age was 68 (56–79) years old and 58 patients had previously known VTE. Overall, VTE occurred in 60 patients (7.8%): 43 pulmonary embolisms (PE), 15 isolated deep vein thrombosis and 2 superficial vein thrombosis. Of note, 81% of patients had been prescribed an anticoagulant treatment on admission. VTE incidence was higher in patients with more severe forms of pneumonia defined as either leading to death, and/or requiring intubation/high flow nasal oxygen/non-invasive ventilation (21% versus 2%, P < 0.001). Overall mortality was 21% and death rate was higher in patients that presented a VTE event (35% versus 20%, P = 0.012). Among VTE patients, a search for LAC was performed in 72% of them and came back positive in 88% of cases. Overall, 33 major bleeding complications (4.3%) were observed of which 42% were intracranial. Conclusion Our study showed that in-hospital VTE occurred more frequently in case of severe COVID-19 pneumonia and was associated with higher death rates.

Enhancing Pulmonary Embolism Mortality Risk Stratification Using Machine Learning: The Role of the Neutrophil-to-Lymphocyte Ratio

“…The COVID-19 pandemic has notably intensified the focus on managing patients with pulmonary embolism (PE), primarily due to the hypercoagulability associated with the virus [ 9 ]. This heightened interest has also been driven by the well-established link between COVID-19 and a wide array of thrombotic complications [ 10 , 11 , 12 ].…”