Preprint Article Version 1 This version is not peer-reviewed

Incidence of Venous Thromboembolism in Hospitalized Patients with COVID-19

Version 1 : Received: 18 April 2020 / Approved: 19 April 2020 / Online: 19 April 2020 (13:08:16 CEST)

How to cite: Middeldorp, S.; Coppens, M.; van Haaps, T.F.; Foppen, M.; Vlaar, A.P.; Muller, M.C.; Bouman, C.C.; Beenen, L.F.; Kootte, R.S.; Heijmans, J.; Smits, L.P.; Bonta, P.I.; van Es, N. Incidence of Venous Thromboembolism in Hospitalized Patients with COVID-19. Preprints 2020, 2020040345 (doi: 10.20944/preprints202004.0345.v1). Middeldorp, S.; Coppens, M.; van Haaps, T.F.; Foppen, M.; Vlaar, A.P.; Muller, M.C.; Bouman, C.C.; Beenen, L.F.; Kootte, R.S.; Heijmans, J.; Smits, L.P.; Bonta, P.I.; van Es, N. Incidence of Venous Thromboembolism in Hospitalized Patients with COVID-19. Preprints 2020, 2020040345 (doi: 10.20944/preprints202004.0345.v1).

Abstract

Coronavirus disease 2019 (COVID-19) can lead to systemic coagulation activation and thrombotic complications. We investigated the incidence of objectively confirmed venous thromboembolism (VTE) in 198 hospitalized patients with COVID-19 in a single-center cohort study. Seventy-four patients (37%) were admitted to the intensive care unit (ICU). At time of data collection, 58 (29%) were still hospitalized and 14% had died. During a median follow-up of 5 days (IQR, 3-9), 33 patients (17%) were diagnosed with VTE of whom 22 (11%) had symptomatic VTE, despite routine thrombosis prophylaxis. The cumulative incidences of VTE at 7 and 14 days were 15% (95% CI, 9.3-22) and 34% (95% CI, 23-46), respectively. For symptomatic VTE, these were 11% (95% CI, 5.8-17) and 23% (95% CI, 14-33). VTE appeared to be associated with death (adjusted HR, 2.9; 95% CI, 1.02-8.0). The cumulative incidence of VTE was higher in the ICU (25% at 7 days 95% CI, 15-36, and 48% at 14 days, 95% CI, 33-61) than on the wards (any VTE and symptomatic VTE 6.5 % at 7 days (95% CI, 1.5-17) and 10% at 14 days (95% CI, 2.9-24)).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.

Subject Areas

COVID-19; venous thrombosis; pulmonary embolism; venous thromboembolism; anticoagulants; mortality

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