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Incidence of venous thromboembolism in hospitalized patients with COVID-19

Saskia Middeldorp1, Michiel Coppens1, Thijs F van Haaps1

  • 1Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Journal of Thrombosis and Haemostasis : JTH
|May 6, 2020
PubMed

Insights

Hospitalized patients with COVID-19 have a high risk of venous thromboembolism (VTE), especially those in the intensive care unit (ICU). This highlights the need for increased clinical suspicion and diagnostic imaging for VTE in these patients.

Area of Science:

  • Medicine
  • Pulmonology
  • Critical Care Medicine

Background:

  • Coronavirus disease 2019 (COVID-19) is associated with systemic coagulation activation.
  • Thrombotic complications are a significant concern in COVID-19 patients.

Purpose of the Study:

  • To determine the incidence of objectively confirmed venous thromboembolism (VTE) in hospitalized COVID-19 patients.
  • To assess the risk of VTE in relation to intensive care unit (ICU) admission and patient outcomes.

Main Methods:

  • A single-center cohort study was conducted with 198 hospitalized COVID-19 patients.
  • Data were collected during a median follow-up of 7 days.
  • VTE diagnosis was objectively confirmed, and symptomatic VTE was specifically noted.

Main Results:

  • 20% of patients were diagnosed with VTE, and 13% had symptomatic VTE, despite routine prophylaxis.
  • The cumulative incidence of VTE at 21 days was 42%, and symptomatic VTE was 25%.
  • VTE was associated with an increased risk of death (adjusted HR, 2.4), with higher incidences observed in ICU patients compared to those on general wards.

Conclusions:

  • The risk of VTE in hospitalized COVID-19 patients is high, particularly in the ICU.
  • A high level of clinical suspicion and a low threshold for diagnostic imaging (for deep vein thrombosis [DVT] or pulmonary embolism [PE]) are recommended.
  • Future research should focus on optimizing VTE diagnostic and prophylactic strategies to improve survival in COVID-19 patients.
Abstract

Keywords:
COVID-19critically illlow-molecular-weight heparinpulmonary embolismvenous thrombosis

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