Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy

Thromb Res. 2020 Jul;191:9-14. doi: 10.1016/j.thromres.2020.04.024. Epub 2020 Apr 23.

Abstract

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.

Keywords: COVID-19; Cardiovascular complications; Disseminated intravascular coagulation; Mortality; SARS-CoV2; Venous thromboembolism.

MeSH terms

  • Acute Coronary Syndrome / epidemiology
  • Acute Coronary Syndrome / etiology
  • Aged
  • Aged, 80 and over
  • Ambulatory Care
  • Anticoagulants / therapeutic use
  • Arterial Occlusive Diseases / diagnostic imaging
  • Arterial Occlusive Diseases / epidemiology
  • Arterial Occlusive Diseases / etiology*
  • Brain Ischemia / epidemiology
  • Brain Ischemia / etiology
  • Comorbidity
  • Coronary Thrombosis / diagnostic imaging
  • Coronary Thrombosis / epidemiology
  • Coronary Thrombosis / etiology
  • Coronavirus Infections / complications*
  • Critical Care
  • Disseminated Intravascular Coagulation / epidemiology
  • Disseminated Intravascular Coagulation / etiology
  • Female
  • Hospital Mortality
  • Hospitals, Teaching / statistics & numerical data
  • Hospitals, Urban / statistics & numerical data
  • Humans
  • Italy / epidemiology
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Pandemics
  • Patient Admission
  • Pneumonia, Viral / complications*
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / epidemiology
  • Pulmonary Embolism / etiology
  • Retrospective Studies
  • Risk Factors
  • Thrombophilia / drug therapy
  • Thrombophilia / etiology*
  • Venous Thromboembolism / diagnostic imaging
  • Venous Thromboembolism / epidemiology
  • Venous Thromboembolism / etiology*

Substances

  • Anticoagulants

Supplementary concepts

  • COVID-19