Prevalence and Predictors of Venous Thromboembolism or Mortality in Hospitalized COVID-19 Patients

Cohen, Stuart L.; Gianos, Eugenia; Barish, Mathew A.; Chatterjee, Saurav; Kohn, Nina; Lesser, Martin; Giannis, Dimitrios; Coppa, Kevin; Hirsch, Jamie S.; McGinn, Thomas; Goldin, Mark; Spyropoulos, Alex C.

doi:10.1055/a-1366-9656

Cited by 65 publications

(93 citation statements)

References 24 publications

(46 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Further, 17% of our patients on therapeutic anticoagulation received it empirically and for presumed PE without undergoing definitive testing; this may have lowered the precision of our estimates of VTE ( Supplemental Material 6 , www.thejh.org ). Our rates of VTE are comparable to the study of Cohen et al, who also reported overall VTE rate to be 2.9% in 9,407 patients in New York area [ 17 ].…”

Section: Discussionsupporting

confidence: 89%

Incidence of Venous Thromboembolism and Effect of Anticoagulant Dosing in Hospitalized COVID-19 Patients

et al. 2021

View full text Add to dashboard Cite

Background Coronavirus disease 2019 (COVID-19) is characterized by coagulopathy and thrombotic events. We examined factors associated with development of venous thromboembolism (VTE) in COVID-19 and to discern if higher dose of anticoagulation was beneficial in these patients. Methods This study involves an observational study of prospectively collected data in the setting of a large community hospital in a rural setting in Northeast Georgia with COVID-19 between March 1, 2020 and February 5, 2021. Anticoagulation dose (none, standard, intermediate, and therapeutic dosages) was studied in adult patients (≥ 18 years). We constructed multivariable logistic regression model to examine the association of clinical characteristics with VTE. To examine the effect of dose of anticoagulation in preventing VTE, we used inverse probability weighted regression adjustment. Results Of the 4,645 patients with COVID-19, 251 (5.4%) patients were found to have VTE. Of these, 91 had pulmonary embolism, 148 had deep venous thrombosis (DVT) and 12 had both. A total of 129 of VTE cases were diagnosed at admission. Of all admissions, 12.9% did not receive any DVT prophylaxis, 70.4% received prophylactic dose, 1.3% received intermediate dose and 15.5% received therapeutic dose. Male gender (odds ratio (OR): 1.55, 95% confidence interval (CI): 1.0 - 2.4, P = 0.04) and Black race (OR: 2.0, 95% CI: 1.2 - 3.4, P = 0.01), along with higher levels of lactate dehydrogenase (LDH) and D-dimer were associated with higher odds of developing VTE. Patients receiving steroids had lower rates of VTE (3.9% vs. 8.3%, P < 0.001). Use of intermediate or therapeutic anticoagulation was not associated with lower odds of developing VTE. However, patients on therapeutic anticoagulation had lower odds of in hospital mortality when compared to standard dose (OR: 0.47, 95% CI: 0.27 - 0.80, P = 0.006). Conclusions In COVID-19, D-dimer and LDH can be useful in predicting VTE. Steroids appear to have some protective role in development of VTE. Therapeutic anticoagulation did not result in lower rates of VTE but was associated with in-hospital mortality.

show abstract

Section: Discussionsupporting

confidence: 89%

Incidence of Venous Thromboembolism and Effect of Anticoagulant Dosing in Hospitalized COVID-19 Patients

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In a large American cohort study of 9407 adult COVID-19 patients, the overall in-hospital venous thromboembolism (VTE) was approximately 3%. The authors concluded that key predictors of VTE or mortality included advanced age, increasing CCI, past history of cardiovascular disease, ICU level of care, and elevated level of D-dimer [35]. In addition, several radiologists tried to differentiate COVID-19 from Influenza and other viral pneumonia on chest CT images [36].…”

Section: Discussionmentioning

confidence: 99%

A Comparative Systematic Review of COVID-19 and Influenza

Osman

Klopfenstein

Belfeki³

et al. 2021

Viruses

View full text Add to dashboard Cite

Background: Both SARS-CoV-2 and influenza virus share similarities such as clinical features and outcome, laboratory, and radiological findings. Methods: Literature search was done using PubMed to find MEDLINE indexed articles relevant to this study. As of 25 November 2020, the search has been conducted by combining the MeSH words “COVID-19” and “Influenza”. Results: Eighteen articles were finally selected in adult patients. Comorbidities such as cardiovascular diseases, diabetes, and obesity were significantly higher in COVID-19 patients, while pulmonary diseases and immunocompromised conditions were significantly more common in influenza patients. The incidence rates of fever, vomiting, ocular and otorhinolaryngological symptoms were found to be significantly higher in influenza patients when compared with COVID-19 patients. However, neurologic symptoms and diarrhea were statistically more frequent in COVID-19 patients. The level of white cell count and procalcitonin was significantly higher in influenza patients, whereas thrombopenia and elevated transaminases were significantly more common in COVID-19 patients. Ground-grass opacities, interlobular septal thickening, and a peripheral distribution were more common in COVID-19 patients than in influenza patients where consolidations and linear opacities were described instead. COVID-19 patients were significantly more often transferred to intensive care unit with a higher rate of mortality. Conclusions: This study estimated differences of COVID-19 and influenza patients which can help clinicians during the co-circulation of the two viruses.

show abstract

“…In addition, D-dimer levels greater than 4 or 6 times the upper limit of normal or elevated SIC scores have been recognized as independent predictors of thrombotic events and poor outcomes (14). Consistent with these findings, multivariate analysis using data from a cohort of 9407 patients with COVID-19 hospitalized at Northwell Health revealed that compared with lower levels, D-dimer levels 4-6 times the upper limit of normal were associated with a 2.1-fold higher risk of VTE or mortality (28). Accordingly, this trial uses inclusion criteria anchored on D-dimers at least 4 times the ULN or an SIC score of 4 or more to ensure enrollment of a high risk population.…”

Section: Accepted Manuscriptmentioning

confidence: 74%

Treatment-Dose LMWH versus Prophylactic/Intermediate Dose Heparins in High-Risk COVID-19 Inpatients: Rationale and Design of the HEP-COVID Trial

et al. 2021

Self Cite

View full text Add to dashboard Cite

Coronavirus disease-2019 (COVID-19) has been associated with significant risk of venous thromboembolism (VTE), arterial thromboembolism (ATE), and mortality particularly among hospitalized patients with critical illness and elevated D-dimer (Dd) levels. Conflicting data have yet to elucidate optimal thromboprophylaxis dosing. HEP-COVID (NCT04401293) is a Phase 3, multicenter, pragmatic, prospective, randomized, pseudo-blinded, active control trial to evaluate efficacy and safety of therapeutic-dose low molecular weight heparin (LMWH) versus prophylactic-/intermediate-dose LMWH or unfractionated heparin (UFH) for prevention of a primary efficacy composite outcome of VTE, ATE, and all-cause mortality (ACM) 30 ± 2 days post-enrollment. Eligible patients have COVID-19 diagnosis by nasal swab or serologic testing, requirement for supplemental oxygen per investigator judgment, and Dd >4x upper limit of normal (ULN) or sepsis-induced coagulopathy (SIC) score ≥4. Subjects are randomized to enoxaparin 1 mg/kg SQ/BID (CrCl ≥ 30 ml/min) or 0.5 mg/kg (CrCl 15-30 ml/min) vs local institutional prophylactic regimens including: a) UFH up to 22,500 IU daily (divided BID or TID), b) enoxaparin 30mg and 40mg SQ QD or BID, or c) dalteparin 2500IU or 5000 IU QD. The principal safety outcome is major bleeding. Events are adjudicated locally. Based on expected 40% relative risk reduction (RRR) with treatment-dose compared with prophylactic-dose prophylaxis, 308 subjects will be enrolled (assuming 20% drop-out) to achieve 80% power. Distinguishing design features include an enriched population for the composite endpoint anchored on Dd >4x ULN, stratification by ICU vs non-ICU, and the ability to capture asymptomatic proximal deep venous thrombosis via screening ultrasonography prior to discharge.

show abstract

Prevalence and Predictors of Venous Thromboembolism or Mortality in Hospitalized COVID-19 Patients

Cited by 65 publications

References 24 publications

Incidence of Venous Thromboembolism and Effect of Anticoagulant Dosing in Hospitalized COVID-19 Patients

Incidence of Venous Thromboembolism and Effect of Anticoagulant Dosing in Hospitalized COVID-19 Patients

A Comparative Systematic Review of COVID-19 and Influenza

Treatment-Dose LMWH versus Prophylactic/Intermediate Dose Heparins in High-Risk COVID-19 Inpatients: Rationale and Design of the HEP-COVID Trial

Contact Info

Product

Resources

About