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Published on: June 2, 2015
Deep Vein Thrombosis in Hospitalized Patients With COVID-19 in Wuhan, China: Prevalence, Risk Factors, and Outcome
Li Zhang1,2, Xiaokai Feng3, Danqing Zhang1,2
1Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Li Zhang, D.Z., J.W., C.Z., H.L., X.X., S.K., J.L., H.J., X.P., Y.S., Y.T., B.W., C.W., H.Y., Yongxing Zhang, Y.L., W.S., Yanting Zhang, S.Z., S.W., Y.X., M.X.).
Insights
Deep vein thrombosis (DVT) affects nearly half of hospitalized COVID-19 patients, increasing mortality risk. Early prophylaxis may benefit high-risk individuals, suggesting COVID-19 is an independent DVT risk factor.
Area of Science:
- Medicine
- Infectious Diseases
- Cardiology
Background:
- Deep vein thrombosis (DVT) is a serious concern in hospitalized patients.
- The prevalence and risk factors for DVT in coronavirus disease 2019 (COVID-19) patients require further investigation.
Purpose of the Study:
- To determine the prevalence of DVT in hospitalized COVID-19 patients.
- To identify risk factors, prognosis, and effective thromboprophylaxis strategies for DVT in this population.
Main Methods:
- A single institutional study was conducted on 143 hospitalized COVID-19 patients.
- Demographic, clinical, and laboratory data were collected, including lower extremity ultrasound scans.
- Comparisons were made between patients with and without DVT.
Main Results:
- The prevalence of lower extremity DVT was 46.1% (66/143 patients).
- Patients with DVT were older, had lower oxygenation, higher cardiac injury rates, and worse outcomes (increased mortality, decreased discharge rates).
- Independent risk factors for DVT included CURB-65 score ≥3, Padua prediction score ≥4, and D-dimer >1.0 μg/mL.
Conclusions:
- High DVT prevalence in COVID-19 patients is linked to adverse outcomes.
- Venous thromboembolism prophylaxis may be beneficial for high-risk patients (Padua score ≥4).
- COVID-19 may be an independent risk factor for DVT in hospitalized patients.
Background:
To investigate deep vein thrombosis (DVT) in hospitalized patients with coronavirus disease 2019 (COVID-19), we performed a single institutional study to evaluate its prevalence, risk factors, prognosis, and potential thromboprophylaxis strategies in a large referral and treatment center.
Methods:
We studied a total of 143 patients with COVID-19 from January 29, 2020 to February 29, 2020. Demographic and clinical data, laboratory data, including ultrasound scans of the lower extremities, and outcome variables were obtained, and comparisons were made between groups with and without DVT.
Results:
Of the 143 patients hospitalized with COVID-19 (age 63±14 years, 74 [51.7%] men), 66 patients developed lower extremity DVT (46.1%: 23 [34.8%] with proximal DVT and 43 [65.2%] with distal DVT). Compared with patients who did not have DVT, patients with DVT were older and had a lower oxygenation index, a higher rate of cardiac injury, and worse prognosis, including an increased proportion of deaths (23 [34.8%] versus 9 [11.7%]; P=0.001) and a decreased proportion of patients discharged (32 [48.5%] versus 60 [77.9%]; P<0.001). Multivariant analysis showed an association only between CURB-65 (confusion status, urea, respiratory rate, and blood pressure) score 3 to 5 (odds ratio, 6.122; P=0.031), Padua prediction score ≥4 (odds ratio, 4.016; P=0.04), D-dimer >1.0 μg/mL (odds ratio, 5.818; P<0.014), and DVT in this cohort, respectively. The combination of a CURB-65 score 3 to 5, a Padua prediction score ≥4, and D-dimer >1.0 μg/mL has a sensitivity of 88.52% and a specificity of 61.43% for screening for DVT. In the subgroup of patients with a Padua prediction score ≥4 and whose ultrasound scans were performed >72 hours after admission, DVT was present in 18 (34.0%) patients in the subgroup receiving venous thromboembolism prophylaxis versus 35 (66.0%) patients in the nonprophylaxis group (P=0.010).
Conclusions:
The prevalence of DVT is high and is associated with adverse outcomes in hospitalized patients with COVID-19. Prophylaxis for venous thromboembolism may be protective in patients with a Padua protection score ≥4 after admission. Our data seem to suggest that COVID-19 is probably an additional risk factor for DVT in hospitalized patients.
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