Venous Thromboembolism in Hospitalized COVID-19 Patients Treated in a Single Academic Center in Mexico: A Case Series Study

Abstract

Background The increasing prevalence of venous thromboembolism (VTE) among patients with coronavirus disease 2019 (COVID-19) is a matter of concern as it contributes significantly to patients' morbidity and mortality. Data regarding the optimal anticoagulation regimen for VTE prevention and treatment remain scarce. This study describes the characteristics, treatment, and outcomes of COVID-19 patients with VTE treated in a single academic center in Mexico. Methods We conducted a retrospective study of all patients with a positive PCR test for SARS-CoV-2 hospitalized in a single academic center in Monterrey, Mexico, between March 2020 and February 2021, with a radiologically confirmed VTE, including deep venous thrombosis (DVT) and pulmonary embolism (PE). Informed consent was obtained from each patient before reviewing their medical records. Results Of the 2000 COVID-19 hospitalized patients, 36 (1.8%) developed VTE and were included in the analysis. The median age was 60 years (range 32-88 years), and up to 78% (n = 28) were males. Most patients (n = 34, 94%) had an underlying comorbidity and 47% (n = 17) had a BMI ≥ 30 kg/m2. In most cases (n=28, 78%), VTE presented as a PE, whereas the remaining 22% (n = 8) had a DVT. The median time between hospital admission and VTE was 8 days (range 0-33 days). Regarding the thromboprophylaxis regimen, 35/36 patients received low molecular weight heparin enoxaparin on admission, most commonly at a dose of 60 mg daily (n = 19, 53%). Other complications presented were superinfection (n = 19, 53%), acute kidney injury (n = 11, 31%), and septic shock (n = 5, 14%). A total of 69% of patients (n = 25) required intensive care unit admission, and patients' overall mortality was 55.6%. Conclusion VTE remains a significant cause of increased morbidity and mortality among patients with COVID-19. The strikingly high mortality among patients with VTE highlights the need for further investigation regarding the best preventive, diagnostic, and treatment approaches.

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

“…Ad hoc studies evaluating prospectively the temporal trend of DVT incidence in patients hospitalized for COVID-19 are lacking, and we can only extrapolate data by indirect comparison of studies that were carried out at different times of the pandemic. Pooled data from a metanalysis published by Zhang et al during the period March-November 2020 (first wave) showed a cumulative incidence of DVT of 7% in patients hospitalized for COVID-19 outside the ICU [16]; while, two recent studies pertaining to the second phases of the pandemic reported a cumulative incidence of DVT in the range of 1-3% in non-ICU patients, features similar to 4.2% incidence found in the second wave in our study [10,[17][18][19].…”

Readmission After COVID-19 for Late Acute Venous Thrombosis; CASE SERIES and Systematic Review of the Literature

“…It is also unclear why there are also thromboembolic events even with anticoagulation therapy. 6 Some studies showed that angiotensin II stimulates tissue factor expression in endothelial cells, causing the release of plasminogen-activator inhibitors from adipocytes. This mechanism leads to increased coagulation and impaired fibrinolysis, which may still be active after infection resolution.…”

“…PE is the most common thrombotic complication, 6,22 presenting on average 23 days after symptom onset. 7 found that PE had the highest incidence among recovered COVID-19 patients with thromboembolic outcomes, with obese patients especially susceptible to this condition.…”