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Immunothrombosis and COVID-19 ‒ a nested post-hoc analysis from a 3186 patient cohort in a Latin American public

Clarice Antunes de Lima1, Fabio Augusto Rodrigues Gonçalves2, Bruno Adler Maccagnan Pinheiro Besen3

  • 1Divisao de Farmacia, Instituto Central, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.

Clinics (Sao Paulo, Brazil)
|May 15, 2023
PubMed

Insights

COVID-19 patients face a high risk of venous thromboembolism (VTE), even with prophylactic anticoagulation. Vigilance for VTE is crucial in severe COVID-19 cases, as incidence remains significant despite preventative measures.

Area of Science:

  • Internal Medicine
  • Critical Care Medicine
  • Hematology

Background:

  • COVID-19 is linked to increased risks of thromboembolism and mortality.
  • Challenges exist in optimal anticoagulation practices for COVID-19 patients.
  • Venous Thromboembolism (VTE) is a significant concern in COVID-19 management.

Purpose of the Study:

  • To analyze the incidence and characteristics of VTE in a cohort of COVID-19 patients.
  • To compare outcomes between COVID-19 patients with and without VTE.
  • To evaluate the effectiveness of prophylactic anticoagulation in preventing VTE in this population.

Main Methods:

  • Post-hoc analysis of a published COVID-19 economic study cohort.
  • Inclusion of adult patients with confirmed COVID-19 and VTE.
  • Utilized the Fine and Gray competing risk model to compare subgroups (VTE vs. no VTE).
  • Analysis of demographic, clinical, and laboratory data, including C-reactive protein and D-dimer levels.

Main Results:

  • A VTE incidence of 7.7% (245/3186) was observed in the COVID-19 cohort.
  • VTE occurred in 5.4% of patients during hospitalization.
  • Patients with VTE exhibited more severe illness, higher mortality, worse SOFA scores, and longer hospital stays.
  • Elevated C-reactive protein and D-dimer were noted in the first week of hospitalization for VTE patients.

Conclusions:

  • Proven VTE incidence was 7.7% in this severe COVID-19 cohort, despite 87% adherence to VTE prophylaxis.
  • Clinicians must maintain a high index of suspicion for VTE in COVID-19 patients, even those on prophylaxis.
  • The findings underscore the persistent risk of VTE in severe COVID-19.
Abstract

Keywords:
BiomarkersCOVID-19Cohort studiesImmunothrombosisVenous thromboembolism

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