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Incidence of venous thromboembolism in hospitalized patients with COVID-19.
J Thromb Haemost. 2020 Aug; 18(8):1995-2002.JT

Abstract

BACKGROUND

Coronavirus disease 2019 (COVID-19) can lead to systemic coagulation activation and thrombotic complications.

OBJECTIVES

To investigate the incidence of objectively confirmed venous thromboembolism (VTE) in hospitalized patients with COVID-19.

METHODS

Single-center cohort study of 198 hospitalized patients with COVID-19.

RESULTS

Seventy-five patients (38%) were admitted to the intensive care unit (ICU). At time of data collection, 16 (8%) were still hospitalized and 19% had died. During a median follow-up of 7 days (IQR, 3-13), 39 patients (20%) were diagnosed with VTE of whom 25 (13%) had symptomatic VTE, despite routine thrombosis prophylaxis. The cumulative incidences of VTE at 7, 14 and 21 days were 16% (95% CI, 10-22), 33% (95% CI, 23-43) and 42% (95% CI 30-54) respectively. For symptomatic VTE, these were 10% (95% CI, 5.8-16), 21% (95% CI, 14-30) and 25% (95% CI 16-36). VTE appeared to be associated with death (adjusted HR, 2.4; 95% CI, 1.02-5.5). The cumulative incidence of VTE was higher in the ICU (26% (95% CI, 17-37), 47% (95% CI, 34-58), and 59% (95% CI, 42-72) at 7, 14 and 21 days) than on the wards (any VTE and symptomatic VTE 5.8% (95% CI, 1.4-15), 9.2% (95% CI, 2.6-21), and 9.2% (2.6-21) at 7, 14, and 21 days).

CONCLUSIONS

The observed risk for VTE in COVID-19 is high, particularly in ICU patients, which should lead to a high level of clinical suspicion and low threshold for diagnostic imaging for DVT or PE. Future research should focus on optimal diagnostic and prophylactic strategies to prevent VTE and potentially improve survival.

Authors+Show Affiliations

Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.Department of Acute Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.Department of Acute Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.Department of Acute Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

32369666

Citation

Middeldorp, Saskia, et al. "Incidence of Venous Thromboembolism in Hospitalized Patients With COVID-19." Journal of Thrombosis and Haemostasis : JTH, vol. 18, no. 8, 2020, pp. 1995-2002.
Middeldorp S, Coppens M, van Haaps TF, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 2020;18(8):1995-2002.
Middeldorp, S., Coppens, M., van Haaps, T. F., Foppen, M., Vlaar, A. P., Müller, M. C. A., Bouman, C. C. S., Beenen, L. F. M., Kootte, R. S., Heijmans, J., Smits, L. P., Bonta, P. I., & van Es, N. (2020). Incidence of venous thromboembolism in hospitalized patients with COVID-19. Journal of Thrombosis and Haemostasis : JTH, 18(8), 1995-2002. https://doi.org/10.1111/jth.14888
Middeldorp S, et al. Incidence of Venous Thromboembolism in Hospitalized Patients With COVID-19. J Thromb Haemost. 2020;18(8):1995-2002. PubMed PMID: 32369666.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence of venous thromboembolism in hospitalized patients with COVID-19. AU - Middeldorp,Saskia, AU - Coppens,Michiel, AU - van Haaps,Thijs F, AU - Foppen,Merijn, AU - Vlaar,Alexander P, AU - Müller,Marcella C A, AU - Bouman,Catherine C S, AU - Beenen,Ludo F M, AU - Kootte,Ruud S, AU - Heijmans,Jarom, AU - Smits,Loek P, AU - Bonta,Peter I, AU - van Es,Nick, Y1 - 2020/07/27/ PY - 2020/04/16/received PY - 2020/05/01/revised PY - 2020/05/01/accepted PY - 2020/5/6/pubmed PY - 2020/8/15/medline PY - 2020/5/6/entrez KW - COVID-19 KW - critically ill KW - low-molecular-weight heparin KW - pulmonary embolism KW - venous thrombosis SP - 1995 EP - 2002 JF - Journal of thrombosis and haemostasis : JTH JO - J. Thromb. Haemost. VL - 18 IS - 8 N2 - BACKGROUND: Coronavirus disease 2019 (COVID-19) can lead to systemic coagulation activation and thrombotic complications. OBJECTIVES: To investigate the incidence of objectively confirmed venous thromboembolism (VTE) in hospitalized patients with COVID-19. METHODS: Single-center cohort study of 198 hospitalized patients with COVID-19. RESULTS: Seventy-five patients (38%) were admitted to the intensive care unit (ICU). At time of data collection, 16 (8%) were still hospitalized and 19% had died. During a median follow-up of 7 days (IQR, 3-13), 39 patients (20%) were diagnosed with VTE of whom 25 (13%) had symptomatic VTE, despite routine thrombosis prophylaxis. The cumulative incidences of VTE at 7, 14 and 21 days were 16% (95% CI, 10-22), 33% (95% CI, 23-43) and 42% (95% CI 30-54) respectively. For symptomatic VTE, these were 10% (95% CI, 5.8-16), 21% (95% CI, 14-30) and 25% (95% CI 16-36). VTE appeared to be associated with death (adjusted HR, 2.4; 95% CI, 1.02-5.5). The cumulative incidence of VTE was higher in the ICU (26% (95% CI, 17-37), 47% (95% CI, 34-58), and 59% (95% CI, 42-72) at 7, 14 and 21 days) than on the wards (any VTE and symptomatic VTE 5.8% (95% CI, 1.4-15), 9.2% (95% CI, 2.6-21), and 9.2% (2.6-21) at 7, 14, and 21 days). CONCLUSIONS: The observed risk for VTE in COVID-19 is high, particularly in ICU patients, which should lead to a high level of clinical suspicion and low threshold for diagnostic imaging for DVT or PE. Future research should focus on optimal diagnostic and prophylactic strategies to prevent VTE and potentially improve survival. SN - 1538-7836 UR - https://www.unboundmedicine.com/medline/citation/32369666/full_citation L2 - https://doi.org/10.1111/jth.14888 DB - PRIME DP - Unbound Medicine ER -