Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy

TLDR

Few data are available on the rate and characteristics of thromboembolic complications in hospitalized patients with COVID‑19. The study prospectively enrolled 388 symptomatic COVID‑19 patients in Milan, defined thromboembolic complications (VTE, ischemic stroke, ACS/MI) as the primary outcome and overt DIC as a secondary outcome, and recorded that 100 % of ICU patients and 75 % of ward patients received thromboprophylaxis. Thromboembolic events occurred in 28 patients (7.7 % of closed cases, 21 % cumulative; 27.6 % ICU, 6.6 % ward), half within 24 h of admission; VTE imaging confirmed VTE in 16 of 44 tested (36 %) and pulmonary embolism in 10 of 30 CTPA (33 %); ischemic stroke and ACS/MI rates were 2.5 % and 1.1 %, and overt DIC occurred in 8 patients (2.2 %).

Abstract

BackgroundFew data are available on the rate and characteristics of thromboembolic complications in hospitalized patients with COVID-19.MethodsWe 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).ResultsWe 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.ConclusionsThe 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.