Presenting Characteristics, Treatment Patterns, and Outcomes among Patients with Venous Thromboembolism during Hospitalization for COVID-19

Abstract

Venous thromboembolism (VTE) is common in patients with coronavirus disease-2019 (COVID-19). However, limited data exist on patient characteristics, treatments, and outcomes. To describe the clinical characteristics, treatment patterns, and short-term outcomes of patients diagnosed with VTE during hospitalization for COVID-19. This is a prospective multinational study of patients with incident VTE during the course of hospitalization for COVID-19. Data were obtained from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry. All-cause mortality, VTE recurrences, and major bleeding during the first 10 days were separately investigated for patients in hospital wards versus those in intensive care units (ICUs). As of May 03, 2020, a total number of 455 patients were diagnosed with VTE (83% pulmonary embolism, 17% isolated deep vein thrombosis) during their hospital stay; 71% were male, the median age was 65 (interquartile range, 55–74) years. Most patients (68%) were hospitalized in medical wards, and 145 in ICUs. Three hundred and seventeen (88%; 95% confidence interval [CI]: 84–91%) patients were receiving thromboprophylaxis at the time of VTE diagnosis. Most patients (88%) received therapeutic low-molecular-weight heparin, and 15 (3.6%) received reperfusion therapies. Among 420 patients with complete 10-day follow-up, 51 (12%; 95% CI: 9.3–15%) died, no patient recurred, and 12 (2.9%; 95% CI: 1.6–4.8%) experienced major bleeding. The 10-day mortality rate was 9.1% (95% CI: 6.1–13%) among patients in hospital wards and 19% (95% CI: 13–26%) among those in ICUs. This study provides characteristics and early outcomes of patients diagnosed with acute VTE during hospitalization for COVID-19. Additional studies are needed to identify the optimal strategies to prevent VTE and to mitigate adverse outcomes associated.

Recent Randomized Trials of Antithrombotic Therapy for Patients With COVID-19

“…In addition, postmortem studies show frequent evidence of microvascular thrombosis in patients with COVID-19 ( 7 , 8 ). The influence of these events on mortality rates remains unknown ( 9 ).…”

Systematic testing for venous thromboembolism in hospitalized patients with COVID-19 and raised D-dimer levels

“…The RIETE ( R egistro I nformatizado de E nfermedad T rombo E mbólica) Registry is an ongoing, multicenter, international, observational registry of consecutive patients with objectively confirmed acute VTE ( ClinicalTrials.gov identifier: NCT02832245). Since March 25, 2020, the Steering Committee of RIETE agreed to prospectively incorporate new data elements related to patients with COVID-19 [ 21 ]. The current study describes the results of a call to recruit data from hospitalized patients with COVID-19 that underwent diagnostic tests for VTE (either deep vein thrombosis [DVT] or pulmonary embolism [PE]) because of raised D-dimer levels.…”

Incidence of pulmonary embolism in patients with non-invasive respiratory support during COVID-19 outbreak

“…The main reasons for the development of thrombotic complications in COVID-19 are uncontrolled inflammatory reaction and coagulopathy in the context of significant endothelial dysfunction ( 16 ). These physio-pathological processes are present in all the stages of the disease with special relevance in patients requiring intensive care unit (ICU) ( 8 , 9 ). However, up to the present time, there are no studies clearly identifying patients at high risk in early stages of SARS-CoV-2 infection.…”

“…In line with this, while the incidence of thrombotic complications in critically ill patients is very high, in patients under non-invasive respiratory support (NIS) is still unknown ( 6 , 7 ). The specific incidence of thrombotic events in each of the clinical scenarios within the broad spectrum of severity of COVID-19, is not clearly established, and this has not allowed the implementation of thromboprophylaxis or anticoagulation for routine care in COVID-19 ( 8 , 9 ). In this context, the purpose of the present study was to investigate the cumulative incidence of PE in COVID-19 patients receiving NIS for respiratory failure during their hospitalization.…”