Incidence of venous thromboembolism in coronavirus disease 2019: An experience from a single large academic center

Infection with the novel severe acute respiratory syndrome coronavirus 2 has been associated with a hypercoagulable state. Emerging data from China and Europe have consistently shown an increased incidence of venous thromboembolism (VTE). We aimed to identify the VTE incidence and early predictors o...

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Published in:	Journal of vascular surgery. Venous and lymphatic disorders (New York, NY) Vol. 9; no. 3; pp. 585 - 591.e2
Main Authors:	Rali, Parth, O'Corragain, Oisin, Ali, Nadia, Lakhter, Vladimir, Caricchio, Roberto, Gupta, Rohit, Rao, A. Koneti, Mishkin, Aaron, Rastogi, Abhinav, Diamond, Adam, Satti, Aditi, Soliman, Ahmed, Goldberg, Amy, Kambo, Amy, Gangemi, Andrew, Vaidya, Anjali, Basil, Anuj, Bakhos, Charles T., Cornwell, Bill, Sanguily, Brianna, Corso, Brittany, Myers, Catherine, Bakhos, Charles, Reddy Mandapati, Chenna Kesava, Erkmen, Cherie, Crabbe, Deborah, Simon, Daniele, Ciccolella, David, Fehrle, Dolores, Cronin, Edmund, Dominguez, Eduardo, Hamad, Eman, Male, Eneida, Narewski, Erin, Jaffe, Frederic, Galli, Jonathan, Garfield, Jamie, D'Alonzo, Gilbert, Millio, Gregory, Simborio, Hannah, Alvarado, Hernan, Oriaku, Ifeoma, Brown, James, Garfield, Jamie L., Stewart, Jeffrey, Murray, Jenna, Travaline, John M., Cooper, Joshua, Song, Jun, Loukmane, Karim, Brennan, Kathleen, Johnson, Keith, Carney, Kevin, Miller, Lauren, Samuels, Llera A., Kerper, Margaret, Marcinkienwicz, Mariola, Aksoy, Mark, Wolfson, Marla, Marron, Robert, Patel, Maulin, Navaro, Melissa, Brisco-Bacik, Meredith A., Gannon, Michael, Kaur, Navjot, Nadpara, Neil, Desai, Nicole, Mills, Nicole, Sheriff, Omar, Abramian, Osheen, Mulhall, Patrick, Varghe, Priju, Dubal, Puja, Alashram, Rami, Armbruster, Rebecca A., Soans, Rohit, Pettigrew, Samantha, Wallace, Samantha, Sehgal, Sameep, Krachman, Samuel, Hoang, Sarah, Duffy, Sean, Weaver, Sheila, George, Sheril, Brictson, Stephanie, Priest, Stephen, Codella, Steve, Kelsen, Steven G., Verga, Steven, Bolla, Sudhir, Karhadkar, Sunil, Shariff, Tahseen, Hooper, Thomas, Sajjan, Uma, Cabey, Whitney, Chatila, Wissam, Li, Wuyan, Dorey-Stein, Zachariah, Repanshek, Zachary D.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-05-2021 by the Society for Vascular Surgery. Published by Elsevier Inc
Subjects:	Computed Tomography Angiography - methods COVID-19 - blood COVID-19 - complications COVID-19 - epidemiology COVID-19 and venous disease COVID-19 coagulopathy COVID-19 VTE Female Fibrin Fibrinogen Degradation Products - analysis Humans Hypercoagulable state in COVID-19 Incidence Male Middle Aged Philadelphia - epidemiology Prognosis Pulmonary Embolism - diagnosis Pulmonary Embolism - epidemiology Pulmonary Embolism - etiology Respiration, Artificial - methods Retrospective Studies Risk Factors SARS-CoV-2 Thrombophilia - blood Thrombophilia - diagnosis Thrombophilia - etiology Ultrasonography, Doppler, Duplex - methods Venous Thrombosis - diagnosis Venous Thrombosis - epidemiology Venous Thrombosis - etiology Philadelphia Hypercoagulable state in COVID-19 COVID-19 coagulopathy COVID-19 VTE
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Summary:	Infection with the novel severe acute respiratory syndrome coronavirus 2 has been associated with a hypercoagulable state. Emerging data from China and Europe have consistently shown an increased incidence of venous thromboembolism (VTE). We aimed to identify the VTE incidence and early predictors of VTE at our high-volume tertiary care center. We performed a retrospective cohort study of 147 patients who had been admitted to Temple University Hospital with coronavirus disease 2019 (COVID-19) from April 1, 2020 to April 27, 2020. We first identified the VTE (pulmonary embolism [PE] and deep vein thrombosis [DVT]) incidence in our cohort. The VTE and no-VTE groups were compared by univariable analysis for demographics, comorbidities, laboratory data, and treatment outcomes. Subsequently, multivariable logistic regression analysis was performed to identify the early predictors of VTE. The 147 patients (20.9% of all admissions) admitted to a designated COVID-19 unit at Temple University Hospital with a high clinical suspicion of acute VTE had undergone testing for VTE using computed tomography pulmonary angiography and/or extremity venous duplex ultrasonography. The overall incidence of VTE was 17% (25 of 147). Of the 25 patients, 16 had had acute PE, 14 had had acute DVT, and 5 had had both PE and DVT. The need for invasive mechanical ventilation (adjusted odds ratio, 3.19; 95% confidence interval, 1.07-9.55) and the admission D-dimer level ≥1500 ng/mL (adjusted odds ratio, 3.55; 95% confidence interval, 1.29-9.78) were independent markers associated with VTE. The all-cause mortality in the VTE group was greater than that in the non-VTE group (48% vs 22%; P = .007). Our study represents one of the earliest reported from the United States on the incidence rate of VTE in patients with COVID-19. Patients with a high clinical suspicion and the identified risk factors (invasive mechanical ventilation, admission D-dimer level ≥1500 ng/mL) should be considered for early VTE testing. We did not screen all patients admitted for VTE; therefore, the true incidence of VTE could have been underestimated. Our findings require confirmation in future prospective studies.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 The list of the Temple University COVID-19 Research Group members is available in the Appendix (online only).
ISSN:	2213-333X 2213-3348
DOI:	10.1016/j.jvsv.2020.09.006