Deep vein thrombosis in hospitalized patients with coronavirus disease 2019

Abstract

Objective The pandemic of coronavirus disease 2019 (COVID-19) has caused devastating morbidity and mortality worldwide. In particular, thromboembolic complications have emerged as a key threat for patients with COVID-19. We assessed our experience with deep vein thrombosis (DVT) in patients with COVID-19. Methods We performed a retrospective analysis of all patients with COVID-19 who had undergone upper or lower extremity venous duplex ultrasonography at an academic health system in New York City from March 3, 2020 to April 12, 2020 with follow-up through May 12, 2020. A cohort of hospitalized patients without COVID-19 (non–COVID-19) who had undergone venous duplex ultrasonography from December 1, 2019 to December 31, 2019 was used for comparison. The primary outcome was DVT. The secondary outcomes included pulmonary embolism, in-hospital mortality, admission to the intensive care unit, and antithrombotic therapy. Multivariable logistic regression was performed to identify the risk factors for DVT and mortality. Results Of 443 patients (COVID-19, n = 188; and non–COVID-19, n = 255) who had undergone venous duplex ultrasonography, the COVID-19 cohort had had a greater incidence of DVT (31% vs 19%; P = .005) than had the non–COVID-19 cohort. The incidence of pulmonary embolism was not significantly different statistically between the COVID-19 and non–COVID-19 cohorts (8% vs 4%; P = .105). The DVT location in the COVID-19 group was more often distal (63% vs 29%; P < .001) and bilateral (15% vs 4%; P < .001). The duplex ultrasound findings had a significant impact on the antithrombotic plan; 42 patients (72%) with COVID-19 in the DVT group had their therapy escalated and 49 (38%) and 3 (2%) had their therapy escalated and deescalated in the non-DVT group, respectively ( P < .001). Within the COVID-19 cohort, the D-dimer level was significantly greater in the DVT group at admission (2746 ng/mL vs 1481 ng/mL; P = .004) and at the duplex examination (6068 ng/mL vs 3049 ng/mL; P < .01). On multivariable analysis, male sex (odds ratio [OR], 2.27; 95% confidence interval [CI], 1.06-4.87; P = .035), intensive care unit admission (OR, 3.42; 95% CI, 1.02-11.44; P = .046), and extracorporeal membrane oxygenation (OR, 5.5; 95% CI, 1.01-30.13; P = .049) were independently associated with DVT. Conclusions Given the high incidence of venous thromboembolic events in this population, we support the decision to empirically initiate therapeutic anticoagulation for patients with a low bleeding risk and severe COVID-19 infection. Duplex ultrasonography should be reserved for patients with a high clinical suspicion of venous thromboembolism for whom anticoagulation ther...

Clinical characteristics and outcomes of venous thromboembolism in patients hospitalized for COVID-19: Systematic review and meta-analysis

“… Author Country Study Design Sample Size (Total = 12132) VTE/PE/DVT (%) Total = 2029 Age (mean ± SD) years Male (%) BMI (mean ± SD) kg/m2 HTN (%) DM (%) Obesity (%) CVD (%) Smokers (%) Mortality (%) LoS (mean ± SD) days ICU admission Mechanical Ventilation Torres A(16) Mexico cohort 30 DVT; 9 ( 30 ) 60.3 ± 35 vs 55.6 ± 32.6 8 ( 89 ) vs 15 ( 71 ) 32.4 ± 17 vs 29.4 ± 15.7 5 ( 56 ) vs 6 ( 29 ) 2 ( 22 ) vs 11 ( 52 ) 6 ( 66 ) vs 6 ( 29 ) 1 ( 11 ) vs 4 ( 20 ) NA 3 ( 33 ) vs 3 ( 14 ) 7.5 ± 14 vs 12.3 ± 20.7 NA NA Santoliquido A(17) Italy cohort study 84 DVT;10 ( 12 ) 72.0 ± 11.3 vs 67.0 ± 13.8 7 ( 70 ) vs 54 ( 73 ) NA 6 ( 60 ) vs 39 (52.7) 1 ( 10 …”

Pharmacologic Thromboprophylaxis and Thrombosis in Hospitalized Patients with COVID-19: A Pooled Analysis

“…The global ideal score was 16 for noncomparative studies and 24 for comparative studies. Included studies were classified according to the overall MINORS score as having low, [13][14][15][16] moderate, [9][10][11][12] or high risk of bias (<9). Any differences in quality rating were resolved by consensus or adjudication by a fourth reviewer (J.I.Z.…”

“…Of the 35 observational studies included, four were prospective 9,29-31 and the remaining 30 were cross-sectional and retrospective studies. 7,11,30, All studies enrolled hospitalized patients with confirmed diagnosis of COVID-19; 11 focused on intensive care unit (ICU) population. 7,29,30,38,40,42,48,[50][51][52][53] The total numbers of studies reporting the incidence of VTE or bleeding in patients receiving no prophylaxis, standard-dose prophylaxis, intermediate-dose prophylaxis, and therapeuticdose anticoagulants were 7, 32, 8, and 13, respectively.…”

“…Systematic screening for asymptomatic DVT was performed in 16 studies. 9,11,29,30,33,[35][36][37]40,42,[48][49][50]53,55,58 Among the included studies, 6 studies reported bleeding events: 2 utilized the International Society of Thrombosis and Hemostasis bleeding criteria 56,59 ; 1 utilized the World Health Organization bleeding grading system 32 ; 1 defined clinically significant bleeding as any bleeding requiring or resulting in red cell transfusion, cessation of anticoagulation, or administration of reversal agents 54 ; and 2 did not specify the definition for bleeding events. 35,57 For quality appraisal, 31 studies (89%) scored 11 to 13 out of the 16 ideal global score for MINORS index.…”

“…[3][4][5][6] High rates of thrombosis in hospitalized patients with COVID-19 have been reported from centers across the world as the pandemic spread. [7][8][9][10][11] This has led to varying pharmacologic thromboprophylaxis use in cohorts of patients with COVID-19 based on rapidly changing societal guidance, institutional protocols from local expertise, and geographic patterns of practice. [12][13][14][15][16][17][18] Current national and international guidelines recommend universal pharmacologic thromboprophylaxis with subcutaneous low-molecular-weight heparin (LMWH) or unfractionated heparin in hospitalized patients.…”