Venous Thromboembolism in COVID-19

Schulman, Sam; Hu, Yu; Konstantinides, Stavros

doi:10.1055/s-0040-1718532

Cited by 76 publications

(71 citation statements)

References 89 publications

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“…Finally, we observed a significantly higher rate of pulmonary embolism among patients with Covid-19 as compared to patients without Covid-19. Such findings are in line with the previously reported propensity of Covid-19 patients to develop venous thromboembolism due to the prothrombotic state caused by the disease ( 30 ). On the other hand, despite the tendency towards a lower LVEF at presentation in patients with Covid-19, the incidence of ventricular thrombus was overall low and similar to that of patients without Covid-19.…”

Section: Discussionsupporting

confidence: 93%

Impact of COVID-19 pandemic and infection on in hospital survival for patients presenting with acute coronary syndromes: A multicenter registry

D’Ascenzo

Filippo

Borin

et al. 2021

International Journal of Cardiology

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Introduction The impact of Covid-19 on the survival of patients presenting with acute coronary syndrome (ACS) remains to be defined. Methods Consecutive patients presenting with ACS at 18 Centers in Northern-Italy during the Covid-19 outbreak were included. In-hospital all-cause death was the primary outcome. In-hospital cardiovascular death along with mechanical and electrical complications were the secondary ones. A case period (February 20, 2020-May 3, 2020) was compared vs. same-year (January 1–February 19, 2020) and previous-year control periods (February 20–May 3, 2019). ACS patients with Covid-19 were further compared with those without. Results Among 779 ACS patients admitted during the case period, 67 (8.6%) tested positive for Covid-19. In-hospital all-cause mortality was significantly higher during the case period compared to the control periods (6.4% vs. 3.5% vs. 4.4% respectively; p 0.026), but similar after excluding patients with COVID-19 (4.5% vs. 3.5% vs. 4.4%; p 0.73). Cardiovascular mortality was similar between the study groups. After multivariable adjustment, admission for ACS during the COVID-19 outbreak had no impact on in-hospital mortality. In the case period, patients with concomitant ACS and Covid-19 experienced significantly higher in-hospital mortality (25% vs. 5%, p < 0.001) compared to patients without. Moreover, higher rates of cardiovascular death, cardiogenic shock and sustained ventricular tachycardia were found in Covid-19 patients. Conclusion ACS patients presenting during the Covid-19 pandemic experienced increased all-cause mortality, driven by Covid-19 positive status due to higher rates of cardiogenic shock and sustained ventricular tachycardia. No differences in cardiovascular mortality compared to non-pandemic scenarios were reported.

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Section: Discussionsupporting

confidence: 93%

Impact of COVID-19 pandemic and infection on in hospital survival for patients presenting with acute coronary syndromes: A multicenter registry

D’Ascenzo

Filippo

Borin

et al. 2021

International Journal of Cardiology

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“…[12][13][14][15][16][17] Therefore, many studies have focused on identifying the optimal dose of LMWH for in-hospital thromboprophylaxis. 11,[17][18][19][20] In contrast, limited data are available on incidence of symptomatic and subclinical VTE after COVID-19 hospitalization, as systematic screening for VTE in the outpatient setting can be cumbersome. Consequently, the optimal thromboprophylactic strategy after discharge remains mostly unknown.…”

mentioning

confidence: 99%

Venous Thromboembolism in Patients Discharged after COVID-19 Hospitalization

Engelen

Vandenbriele

Balthazar

et al. 2021

Semin Thromb Hemost

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Background Venous thromboembolism (VTE) is a frequent complication of COVID-19, so that the importance of adequate in-hospital thromboprophylaxis in patients hospitalized with COVID-19 is well established. However, the incidence of VTE after discharge and whether postdischarge thromboprophylaxis is beneficial and safe are unclear. In this prospective observational single-center study, we report the incidence of VTE 6 weeks after hospitalization and the use of postdischarge thromboprophylaxis. Methods Patients hospitalized with confirmed COVID-19 were invited to a multidisciplinary follow-up clinic 6 weeks after discharge. D-dimer and C-reactive protein were measured, and all patients were screened for deep vein thrombosis with venous duplex-ultrasound. Additionally, selected high-risk patients received computed tomography pulmonary angiogram or ventilation–perfusion (V/Q) scan to screen for incidental pulmonary embolism. Results Of 485 consecutive patients hospitalized from March through June 2020, 146 patients were analyzed, of which 39% had been admitted to the intensive care unit (ICU). Postdischarge thromboprophylaxis was prescribed in 28% of patients, but was used more frequently after ICU stay (61%) and in patients with higher maximal D-dimer and C-reactive protein levels during hospitalization. Six weeks after discharge, elevated D-dimer values were present in 32% of ward and 42% of ICU patients. Only one asymptomatic deep vein thrombosis (0.7%) and one symptomatic pulmonary embolism (0.7%) were diagnosed with systematic screening. No bleedings were reported. Conclusion In patients who had been hospitalized with COVID-19, systematic screening for VTE 6 weeks after discharge revealed a low incidence of VTE. A strategy of selectively providing postdischarge thromboprophylaxis in high-risk patients seems safe and potentially effective.

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“…Patients hospitalized with COVID-19 appear to be at higher risk of venous thrombosis, due to the interaction between coagulation and virus-related inflammation [ 13 ]. The resulting procoagulant state is mediated by the release inflammatory cytokines [Interleukin 6 (IL-6), Interleukin-8 (IL-8)], tumor necrosis factor α (TNF-α), and chemokines that causes the activation of epithelial cells, monocytes, and neutrophils [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Does chronic oral anticoagulation reduce in-hospital mortality among COVID-19 older patients?

et al. 2021

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Background Patients hospitalized with COVID-19 experienced an increased risk of venous thromboembolism. Aims To evaluate the effect of chronic oral anticoagulation (OAC) therapy, both with vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs), on prognosis of COVID-19 older patients. Methods Single-center prospective study conducted in the Emergency Department (ED) of a teaching hospital, referral center for COVID-19 in central Italy. We evaluated all the patients ≥ 65 years, consecutively admitted to our ED for confirmed COVID-19. We compared the clinical outcome of those who were on chronic OAC at ED admission with those who did not, using a propensity score matched paired cohort of controls. The primary study endpoint was all-cause in-hospital death. Patients were matched for age, sex, clinical comorbidities, and clinical severity at presentation (based on NEWS ≥ 6). Study parameters were assessed for association to all-cause in-hospital death by a multivariate Cox regression analysis to identify independent risk factor for survival. Results Although overall mortality was slightly higher for anticoagulated patients compared to controls (63.3% vs 43.5%, p = 0.012), the multivariate adjusted hazard ratio (HR) for death was not significant (HR = 1.56 [0.78–3.12]; p = 0.208). Both DOACs (HR 1.46 [0.73–2.92]; p = 0.283) and VKAs (HR 1.14 [0.48–2.73]; p = 0.761) alone did not affect overall survival in our cohort. Conclusions Among older patients hospitalized for COVID-19, chronic OAC therapy was not associated with a reduced risk of in-hospital death. Moreover, our data suggest similar outcome both for patients on VKAs or in patients on DOACs. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-01924-w.

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Venous Thromboembolism in COVID-19

Cited by 76 publications

References 89 publications

Impact of COVID-19 pandemic and infection on in hospital survival for patients presenting with acute coronary syndromes: A multicenter registry

Impact of COVID-19 pandemic and infection on in hospital survival for patients presenting with acute coronary syndromes: A multicenter registry

Venous Thromboembolism in Patients Discharged after COVID-19 Hospitalization

Does chronic oral anticoagulation reduce in-hospital mortality among COVID-19 older patients?

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