Clinical characteristics and risk factors for symptomatic venous thromboembolism in hospitalized COVID‐19 patients: A multicenter retrospective study

Abstract

Background: High incidence of asymptomatic venous thromboembolism (VTE) has been observed in severe COVID-19 patients, but the characteristics of symptomatic VTE in general COVID-19 patients have not been described. Objectives: To comprehensively explore the prevalence and reliable risk prediction for VTE in COVID-19 patients. Methods/Results: This retrospective study enrolled all COVID-19 patients with a subsequent VTE in 16 centers in China from January 1 to March 31, 2020. A total of 2779 patients were confirmed with COVID-19. In comparison to 23,434 non-COVID-19 medical inpatients, the odds ratios (ORs) for developing symptomatic VTE in severe and non-severe hospitalized COVID-19 patients were 5.94 (95% confidence interval [CI] 3.91-10.09) and 2.79 (95% CI 1.43-5.60), respectively. When 104 VTE cases and 208 non-VTE cases were compared, pulmonary embolism cases had a higher rate for in-hospital death (OR 6.74, 95% CI 2.18-20.81). VTE developed at a median of 21 days (interquartile range 13.25-31) since onset. Independent factors for VTE were advancing age, cancer, longer interval from symptom onset to admission, lower fibrinogen and higher D-dimer on admission, and D-dimer increment (DI) ≥1.5-fold; of these, DI ≥1.5-fold had the most significant association (OR 14.18, 95% CI 6.25-32.18, p = 2.23 × 10 −10). A novel model consisting of three simple coagulation variables (fibrinogen and D-dimer levels on admission, and DI ≥1.5-fold) showed good prediction for symptomatic VTE (area under the curve 0.865, 95% CI 0.822-0.907, sensitivity 0.930, specificity 0.710). Conclusions: There is an excess risk of VTE in hospitalized COVID-19 patients. This novel model can aid early identification of patients who are at high risk for VTE.

Preventing Thrombohemorrhagic Complications of Heparinized COVID-19 Patients Using Adjunctive Thromboelastography: A Retrospective Study

“…The significance of decreased α-angle in this model may allude to the weak predictability for thrombosis, as hypercoagulable states more consistently demonstrate increased α-angle. D-dimer has been a reliable predictor for thrombosis, and our results corroborate the existing literature [ 15 , 25 , 30 , 31 ].…”

“…This single center, retrospective study corroborates existing literature regarding the high incidence of thrombohemorrhagic complications in severely ill COVID-19 patients [2,9,12,14,15,25,30,31,41,42]. Early in the pandemic, some reports demonstrated high bleeding rates similar to our early findings [12,14,15,25].…”

“…Admission levels of biomarkers (e.g., elevated D-dimer) have been identified as prognostic indicators of thrombohemorrhagic events for COVID-19 patients [15,25,26,30,31]. However, current guidelines no longer recommend empiric escalation to intermediate dosing based on these prognostic factors [32,33].…”

Prevention of venous thromboembolism and haemostasis monitoring in patients with COVID-19: Updated proposals (April 2021)

“…The changes in D-dimers levels over time can also help identify patients likely to develop thrombosis, as a D-dimers increment of 1.5-fold was strongly associated with the diagnosis of thrombosis in COVID-19 patients [33] . Progression curves of D-dimers also showed a rapid increase before the diagnosis of thrombotic events [14] , [34] .…”

Covid-19 E Trombose

“…Muitos autores consideram o valor de corte para d-dímero preditivo de trombose como sendo seis vezes maior do que o limite normal (superior a 3,0 µg/mL) 2,15 . Outros autores consideram valores de corte maiores, como superior a 5,0 µg/mL (S 96% E 10% para TEP) ou a 10,0 µg/mL (S 91% E 24% para TEP) 20 ou ainda um incremento dos valores de d-dímero ao longo do tempo 16 .…”