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Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy.
Thromb Res. 2020 07; 191:9-14.TR

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.

Authors+Show Affiliations

Center for Thrombosis and Hemorrhagic Diseases, Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy; Department of Medical Sciences, Humanitas University, Milano, Italy. Electronic address: corrado.lodigiani@humanitas.it.Department of Anaestesia and Intensive Care, Humanitas Clinical and Research Center, Rozzano, Milano, Italy.Department of Anaestesia and Intensive Care, Humanitas Clinical and Research Center, Rozzano, Milano, Italy.Department of Medical Sciences, Humanitas University, Milano, Italy; Department of Anaestesia and Intensive Care, Humanitas Clinical and Research Center, Rozzano, Milano, Italy.Center for Thrombosis and Hemorrhagic Diseases, Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy.Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland.Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland.Division of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland.Center for Thrombosis and Hemorrhagic Diseases, Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy.Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, via Manzoni 56, 20089 Rozzano, Milan, Italy.Laboratory Medicine Division, Humanitas Clinical and Research Hospital, Rozzano, Milano, Italy.Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland; Center for Thrombosis and Hemostasis, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32353746

Citation

Lodigiani, Corrado, et al. "Venous and Arterial Thromboembolic Complications in COVID-19 Patients Admitted to an Academic Hospital in Milan, Italy." Thrombosis Research, vol. 191, 2020, pp. 9-14.
Lodigiani C, Iapichino G, Carenzo L, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020;191:9-14.
Lodigiani, C., Iapichino, G., Carenzo, L., Cecconi, M., Ferrazzi, P., Sebastian, T., Kucher, N., Studt, J. D., Sacco, C., Bertuzzi, A., Sandri, M. T., & Barco, S. (2020). Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thrombosis Research, 191, 9-14. https://doi.org/10.1016/j.thromres.2020.04.024
Lodigiani C, et al. Venous and Arterial Thromboembolic Complications in COVID-19 Patients Admitted to an Academic Hospital in Milan, Italy. Thromb Res. 2020;191:9-14. PubMed PMID: 32353746.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. AU - Lodigiani,Corrado, AU - Iapichino,Giacomo, AU - Carenzo,Luca, AU - Cecconi,Maurizio, AU - Ferrazzi,Paola, AU - Sebastian,Tim, AU - Kucher,Nils, AU - Studt,Jan-Dirk, AU - Sacco,Clara, AU - Bertuzzi,Alexia, AU - Sandri,Maria Teresa, AU - Barco,Stefano, AU - ,, Y1 - 2020/04/23/ PY - 2020/04/16/received PY - 2020/04/18/revised PY - 2020/04/20/accepted PY - 2020/5/1/pubmed PY - 2020/6/13/medline PY - 2020/5/1/entrez KW - COVID-19 KW - Cardiovascular complications KW - Disseminated intravascular coagulation KW - Mortality KW - SARS-CoV2 KW - Venous thromboembolism SP - 9 EP - 14 JF - Thrombosis research JO - Thromb Res VL - 191 N2 - 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. SN - 1879-2472 UR - https://www.unboundmedicine.com/medline/citation/32353746/Venous_and_arterial_thromboembolic_complications_in_COVID_19_patients_admitted_to_an_academic_hospital_in_Milan_Italy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-3848(20)30140-7 DB - PRIME DP - Unbound Medicine ER -