Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy.
- Lodigiani C Center for Thrombosis and Hemorrhagic Diseases, Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy; Department of Medical Sciences, Humanitas University, Milano, Italy. Electronic address: corrado.lodigiani@humanitas.it.
- Iapichino G Department of Anaestesia and Intensive Care, Humanitas Clinical and Research Center, Rozzano, Milano, Italy.
- Carenzo L Department of Anaestesia and Intensive Care, Humanitas Clinical and Research Center, Rozzano, Milano, Italy.
- Cecconi M Department of Medical Sciences, Humanitas University, Milano, Italy; Department of Anaestesia and Intensive Care, Humanitas Clinical and Research Center, Rozzano, Milano, Italy.
- Ferrazzi P Center for Thrombosis and Hemorrhagic Diseases, Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy.
- Sebastian T Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland.
- Kucher N Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland.
- Studt JD Division of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland.
- Sacco C Center for Thrombosis and Hemorrhagic Diseases, Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy.
- Bertuzzi A Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, via Manzoni 56, 20089 Rozzano, Milan, Italy.
- Sandri MT Laboratory Medicine Division, Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy.
- Barco S Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland; Center for Thrombosis and Hemostasis, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.
- 2020-05-01
Published in:
- Thrombosis research. - 2020
COVID-19
Cardiovascular complications
Disseminated intravascular coagulation
Mortality
SARS-CoV2
Venous thromboembolism
Acute Coronary Syndrome
Aged
Aged, 80 and over
Ambulatory Care
Anticoagulants
Arterial Occlusive Diseases
Brain Ischemia
Comorbidity
Coronary Thrombosis
Coronavirus Infections
Critical Care
Disseminated Intravascular Coagulation
Female
Hospital Mortality
Hospitals, Teaching
Hospitals, Urban
Humans
Italy
Length of Stay
Male
Middle Aged
Pandemics
Patient Admission
Pneumonia, Viral
Pulmonary Embolism
Retrospective Studies
Risk Factors
Thrombophilia
Venous Thromboembolism
English
BACKGROUND
Few data are available on the rate and characteristics of thromboembolic complications in hospitalized patients with COVID-19.
METHODS
We studied consecutive symptomatic patients with laboratory-proven COVID-19 admitted to a university hospital in Milan, Italy (13.02.2020-10.04.2020). The primary outcome was any thromboembolic complication, including venous thromboembolism (VTE), ischemic stroke, and acute coronary syndrome (ACS)/myocardial infarction (MI). Secondary outcome was overt disseminated intravascular coagulation (DIC).
RESULTS
We included 388 patients (median age 66 years, 68% men, 16% requiring intensive care [ICU]). Thromboprophylaxis was used in 100% of ICU patients and 75% of those on the general ward. Thromboembolic events occurred in 28 (7.7% of closed cases; 95%CI 5.4%-11.0%), corresponding to a cumulative rate of 21% (27.6% ICU, 6.6% general ward). Half of the thromboembolic events were diagnosed within 24 h of hospital admission. Forty-four patients underwent VTE imaging tests and VTE was confirmed in 16 (36%). Computed tomography pulmonary angiography (CTPA) was performed in 30 patients, corresponding to 7.7% of total, and pulmonary embolism was confirmed in 10 (33% of CTPA). The rate of ischemic stroke and ACS/MI was 2.5% and 1.1%, respectively. Overt DIC was present in 8 (2.2%) patients.
CONCLUSIONS
The high number of arterial and, in particular, venous thromboembolic events diagnosed within 24 h of admission and the high rate of positive VTE imaging tests among the few COVID-19 patients tested suggest that there is an urgent need to improve specific VTE diagnostic strategies and investigate the efficacy and safety of thromboprophylaxis in ambulatory COVID-19 patients.
Few data are available on the rate and characteristics of thromboembolic complications in hospitalized patients with COVID-19.
METHODS
We studied consecutive symptomatic patients with laboratory-proven COVID-19 admitted to a university hospital in Milan, Italy (13.02.2020-10.04.2020). The primary outcome was any thromboembolic complication, including venous thromboembolism (VTE), ischemic stroke, and acute coronary syndrome (ACS)/myocardial infarction (MI). Secondary outcome was overt disseminated intravascular coagulation (DIC).
RESULTS
We included 388 patients (median age 66 years, 68% men, 16% requiring intensive care [ICU]). Thromboprophylaxis was used in 100% of ICU patients and 75% of those on the general ward. Thromboembolic events occurred in 28 (7.7% of closed cases; 95%CI 5.4%-11.0%), corresponding to a cumulative rate of 21% (27.6% ICU, 6.6% general ward). Half of the thromboembolic events were diagnosed within 24 h of hospital admission. Forty-four patients underwent VTE imaging tests and VTE was confirmed in 16 (36%). Computed tomography pulmonary angiography (CTPA) was performed in 30 patients, corresponding to 7.7% of total, and pulmonary embolism was confirmed in 10 (33% of CTPA). The rate of ischemic stroke and ACS/MI was 2.5% and 1.1%, respectively. Overt DIC was present in 8 (2.2%) patients.
CONCLUSIONS
The high number of arterial and, in particular, venous thromboembolic events diagnosed within 24 h of admission and the high rate of positive VTE imaging tests among the few COVID-19 patients tested suggest that there is an urgent need to improve specific VTE diagnostic strategies and investigate the efficacy and safety of thromboprophylaxis in ambulatory COVID-19 patients.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.thromres.2020.04.024
- PMID 32353746
- Persistent URL
- https://sonar.ch/global/documents/200276
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