Incidence of deep venous thrombosis in COVID-19 hospitalized patients during the first peak of the Italian outbreak

Author:

Baccellieri Domenico1ORCID,Bertoglio Luca1,Apruzzi Luca1,Ardita Vincenzo1,D’Angelo Armando2,Bossi Matteo1,Rinaldi Enrico1,Bilman Victor1,Calvisi Stefania3,Castagna Antonella4,Galli Laura4,Landoni Giovanni5,Melissano Germano1,Querini Patrizia Rovere6,Tresoldi Moreno3,De Cobelli Francesco7,Zangrillo Alberto5ORCID,Ciceri Fabio8,Chiesa Roberto1

Affiliation:

1. Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy

2. Coagulation Service and Thrombosis Research Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

3. Division of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy

4. Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy

5. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy

6. Department of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy

7. Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy

8. Department of Hematology and Stem Cell Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy

Abstract

Objectives A high rate of thrombotic events has been reported in COVID-19 population. The study aims to assess the incidence of deep vein thrombosis (DVT) in COVID-19 patients admitted to a single tertiary hospital. Methods From April 2nd to April 18th, 2020, hospitalized patients with SARS-CoV-2 infection were screened by lower limb duplex ultrasound (DUS). Patients were on (low molecular weight heparin) LMWH prophylaxis in medical wards, and on therapeutic anticoagulation in intensive care unit (ICU). DVT risk factors, reported by the Padua prediction score and blood tests, were retrieved from institutional electronic charts. The study primary endpoint was the incidence of DVT in the in-hospital COVID-19 population and its association with clinical and laboratory risk factors. The secondary endpoint was the association of DVT with mortality. Results Two hundred patients (median age 62 years, 72% male, 40 in ICU) received DUS screening. DVT was observed in 29 patients (14.5%), with proximal extension in 16 patients, and in association with symptoms in four patients. The DVT rate was similar in ICU (12.5%) and non-ICU patients (15%). Eighty-seven patients underwent a computed tomography angiography (CTA) that showed pulmonary embolism in 35 patients (40.2%) not associated with DVT in 25/35 cases (71.4%). DVT in the ten patients with pulmonary embolism were symptomatic in four and with a proximal localization in eight cases. A D-dimer level ≥5 mg/l at admission was predictive of DVT (OR 1.02; IC95% 1.03-1.16; p  = .003). At the multivariate analysis in-hospital mortality was predicted by age (OR 1.06; 95% CI 0.02-1.15; p  = .004) and by being an ICU patient (OR 1.23; 95% CI 0.30-2.25; p  = .01). Conclusions Despite LMWH prophylaxis or full anticoagulant therapy, the incidence of DVT, mainly asymptomatic, in hospitalized COVID-19 patients was 14.5%. Further research should focus on the appropriate antithrombotic therapy for COVID-19 patients.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,General Medicine

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