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Thrombotic risk in COVID-19: a case series and case-control study.
Clin Med (Lond). 2020 07; 20(4):e76-e81.CM

Abstract

BACKGROUND

A possible association between COVID-19 infection and thrombosis, either as a direct consequence of the virus or as a complication of inflammation, is emerging in the literature. Data on the incidence of venous thromboembolism (VTE) are extremely limited.

METHODS

We describe three cases of thromboembolism refractory to heparin treatment, the incidence of VTE in an inpatient cohort, and a case-control study to identify risk factors associated with VTE.

RESULTS

We identified 274 confirmed (208) or probable (66) COVID-19 patients. 21 (7.7%) were diagnosed with VTE. D-dimer was elevated in both cases (confirmed VTE) and controls (no confirmed VTE) but higher levels were seen in confirmed VTE cases (4.1 vs 1.2 μg/mL, p<0.001).

CONCLUSION

Incidence of VTE is high in patients hospitalised with COVID-19. Urgent clinical trials are needed to evaluate the role of anticoagulation in COVID-19. Monitoring of D-dimer and anti-factor Xa levels may be beneficial in guiding management.

Authors+Show Affiliations

Brighton and Sussex University Hospitals NHS Trust, Brighton, UK and Brighton and Sussex Medical School, Falmer, UK s.stoneham@bsms.ac.uk.Brighton and Sussex Medical School, Brighton, UK and Royal Sussex County Hospital, Brighton, UK.Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.Brighton and Sussex Medical School, Brighton UK and Royal Sussex County Hospital, Brighton, UK.Brighton and Sussex University Hospitals NHS Trust, Brighton, UK and Brighton and Sussex Medical School, Falmer, UK.Brighton and Sussex University Hospitals NHS Trust, Brighton, UK and Brighton and Sussex Medical School, Falmer, UK.Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.Brighton and Sussex University Hospitals NHS Trust, Brighton, UK and Brighton and Sussex Medical School, Falmer, UK.Brighton and Sussex Medical School, Brighton UK and consultant haematologist, Royal Sussex County Hospital, Brighton, UK.Brighton and Sussex University Hospitals NHS Trust, Brighton, UK and Brighton and Sussex Medical School, Falmer, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32423903

Citation

Stoneham, Simon M., et al. "Thrombotic Risk in COVID-19: a Case Series and Case-control Study." Clinical Medicine (London, England), vol. 20, no. 4, 2020, pp. e76-e81.
Stoneham SM, Milne KM, Nuttall E, et al. Thrombotic risk in COVID-19: a case series and case-control study. Clin Med (Lond). 2020;20(4):e76-e81.
Stoneham, S. M., Milne, K. M., Nuttall, E., Frew, G. H., Sturrock, B. R., Sivaloganathan, H., Ladikou, E. E., Drage, S., Phillips, B., Chevassut, T. J., & Eziefula, A. C. (2020). Thrombotic risk in COVID-19: a case series and case-control study. Clinical Medicine (London, England), 20(4), e76-e81. https://doi.org/10.7861/clinmed.2020-0228
Stoneham SM, et al. Thrombotic Risk in COVID-19: a Case Series and Case-control Study. Clin Med (Lond). 2020;20(4):e76-e81. PubMed PMID: 32423903.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thrombotic risk in COVID-19: a case series and case-control study. AU - Stoneham,Simon M, AU - Milne,Kate M, AU - Nuttall,Elisabeth, AU - Frew,Georgina H, AU - Sturrock,Beattie Rh, AU - Sivaloganathan,Helena, AU - Ladikou,Eleni E, AU - Drage,Stephen, AU - Phillips,Barbara, AU - Chevassut,Timothy Jt, AU - Eziefula,Alice C, Y1 - 2020/05/18/ PY - 2020/5/20/pubmed PY - 2020/8/4/medline PY - 2020/5/20/entrez KW - COVID-19 KW - D-dimer KW - deep vein thrombosis KW - pulmonary embolism KW - venous thromboembolism SP - e76 EP - e81 JF - Clinical medicine (London, England) JO - Clin Med (Lond) VL - 20 IS - 4 N2 - BACKGROUND: A possible association between COVID-19 infection and thrombosis, either as a direct consequence of the virus or as a complication of inflammation, is emerging in the literature. Data on the incidence of venous thromboembolism (VTE) are extremely limited. METHODS: We describe three cases of thromboembolism refractory to heparin treatment, the incidence of VTE in an inpatient cohort, and a case-control study to identify risk factors associated with VTE. RESULTS: We identified 274 confirmed (208) or probable (66) COVID-19 patients. 21 (7.7%) were diagnosed with VTE. D-dimer was elevated in both cases (confirmed VTE) and controls (no confirmed VTE) but higher levels were seen in confirmed VTE cases (4.1 vs 1.2 μg/mL, p<0.001). CONCLUSION: Incidence of VTE is high in patients hospitalised with COVID-19. Urgent clinical trials are needed to evaluate the role of anticoagulation in COVID-19. Monitoring of D-dimer and anti-factor Xa levels may be beneficial in guiding management. SN - 1473-4893 UR - https://www.unboundmedicine.com/medline/citation/32423903/Thrombotic_risk_in_COVID_19:_a_case_series_and_case_control_study_ DB - PRIME DP - Unbound Medicine ER -