Search

Introduction: Venous thromboembolism (VTE) is reported in up to 27% of patients with COVID‐19 due to SARS‐CoV‐2 infection. Dysregulated systemic inflammation and various patient traits are presumed to underlie this anomaly. Optimal VTE prophylaxis in COVID‐19 patients has not been established due to a lack of validated models for predicting VTE in this population. Our study aims to address this deficiency by identifying demographic and clinical characteristics of COVID‐19 patients associated with increased VTE risk. Methods: This study is a retrospective analysis of all adult patients (final sample, n = 355) hospitalized with confirmed COVID‐19 at Einstein Medical Center Philadelphia between March 1 and April 24, 2020. Demographic and clinical patient data were collected and factors associated with VTE were identified and analyzed using t‐tests, multivariable logistic regression, and receiver operating characteristic (ROC) curves. Results: Thirty patients (8.5%) developed VTE. Patients with VTE had significantly higher D‐dimer levels on admission (P = 0.045) and peak D‐dimer levels (P < 0.0001), in addition to higher rates of vasopressor requirements (P = 0.038), intubation (P = 0.003), and death (P = 0.023). Age (OR 1.042), obstructive sleep apnea (OR 5.107), and need for intubation (OR 3.796) were associated with significantly increased odds of VTE. Peak D‐dimer level was a good predictor of VTE (AUC 0.806, P < 0.0001) and a D‐dimer cutoff of >6640 ng/mL had high (>70%) sensitivity and specificity for VTE. Conclusion: Peak D‐dimer level may be the most reliable clinical marker in COVID‐19 patients for predicting VTE and future prospective studies should attempt to further validate this. [ABSTRACT FROM AUTHOR]

There is paucity of data regarding the outcomes of hospitalized acute pulmonary embolism (PE) patients with heart failure (HF) and Coronavirus Disease 2019 (COVID-19) infection. We utilized the 2020 National Inpatient Sample (NIS) Database in conducting a retrospective cohort study to investigate the outcomes of hospitalized acute PE patients with HF and COVID-19, looking at its impact on inhospital mortality, thrombolysis, and thrombectomy utilization as well as hospital length of stay (LOS). A total of 23,413 hospitalized acute PE patients with HF were identified in our study, of which 1.26% (n=295/23,413) had COVID-19 infection. Utilizing a stepwise survey multivariable logistic regression model that adjusted for confounders, COVID-19 infection among acute PE patients with HF was found to be an independent predictor of overall in-hospital mortality (adjusted odds ratio [aOR]: 2.77; 95% confidence interval [CI], 1.15-6.67; p=0.023) and thrombolysis utilization (aOR: 5.52; 95% CI, 2.57-11.84; p = 0.001) compared to those without COVID-19. However, there were comparable rates of thrombectomy utilization and LOS among acute PE patients with HF regardless of the COVID-19 infection status. On subgroup analysis, patients with HF with reduced ejection fraction was found to be associated with increased risk for in-hospital mortality (aOR: 3.89; 95% CI, 1.33-11.39; p= 0.013) and thrombectomy utilization (aOR: 4.58; 95% CI, 1.08-19.41; p =0.042), whereas both HF subtypes were associated with increased thrombolysis utilization. COVID-19 infection among acute PE patients with HF was associated with higher over-all in-hospital mortality and increased thrombolysis utilization but had comparable hospital LOS as well as thrombectomy utilization. [ABSTRACT FROM AUTHOR]