1. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy.
- Author
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Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, Kucher N, Studt JD, Sacco C, Bertuzzi A, Sandri MT, and Barco S
- Subjects
- Acute Coronary Syndrome epidemiology, Acute Coronary Syndrome etiology, Aged, Aged, 80 and over, Ambulatory Care, Anticoagulants therapeutic use, Arterial Occlusive Diseases diagnostic imaging, Arterial Occlusive Diseases epidemiology, Brain Ischemia epidemiology, Brain Ischemia etiology, COVID-19, Comorbidity, Coronary Thrombosis diagnostic imaging, Coronary Thrombosis epidemiology, Coronary Thrombosis etiology, Critical Care, Disseminated Intravascular Coagulation epidemiology, Disseminated Intravascular Coagulation etiology, Female, Hospital Mortality, Hospitals, Teaching statistics & numerical data, Hospitals, Urban statistics & numerical data, Humans, Italy epidemiology, Length of Stay statistics & numerical data, Male, Middle Aged, Pandemics, Patient Admission, Pulmonary Embolism diagnostic imaging, Pulmonary Embolism epidemiology, Pulmonary Embolism etiology, Retrospective Studies, Risk Factors, Thrombophilia drug therapy, Venous Thromboembolism diagnostic imaging, Venous Thromboembolism epidemiology, Arterial Occlusive Diseases etiology, Coronavirus Infections complications, Pneumonia, Viral complications, Thrombophilia etiology, Venous Thromboembolism etiology
- 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., Competing Interests: Declaration of competing interest Corrado Lodigiani received congress and travel payments from Bayer HealthCare, Daiichi-Sankyo and Boehringer Ingelheim, NovoNordisk, Takeda, and honoraria from Daiichi-Sankyo, Takeda, NovoNordisk, Boehringer Ingelheim, Bayer HealthCare, Aspen, Italfarmaco. Stefano Barco has received congress and travel payments from Daiichi-Sankyo and Bayer HealthCare, and honoraria from Bayer HealthCare and LeoPharma. The other authors do not disclose any potential conflict of interest. The present study was not funded., (Copyright © 2020. Published by Elsevier Ltd.)
- Published
- 2020
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