TOPIC: Pulmonary Vascular Disease
TYPE: Original Investigations
PURPOSE: COVID-19 has been proven to affect multiple organ systems and can lead to a hypercoagulable state resulting in microvascular and macrovascular thrombosis. Since the start of the pandemic, studies have reported variable venous thromboembolism (VTE) rates of up to 75% of hospitalized patients. The aim of the study is to investigate the incidence of VTE in our patient population as well as highlight the success of prophylactic anticoagulation at our institution.
METHODS: We conducted a retrospective chart review of consecutive PCR confirmed COVID-19 admissions. We gathered demographic information, usage of novel oral anticoagulants (NOAC), usage of VTE chemoprophylaxis and Intensive care unit admission. We also gathered incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) diagnosed with a venous duplex ultrasound and Computed Tomography Pulmonary Angiogram, respectively. Lastly, we collected information on comorbidities including end-stage renal disease, chronic kidney disease, acute kidney injury, diabetes mellitus, congestive heart failure, chronic obstructive pulmonary disease, hypertension, asthma, and coronary artery disease. Patients who presented with VTE on admission were excluded.
RESULTS: Five hundred and fifty-six charts were reviewed of which 401 patients were on VTE prophylaxis, 97 patients on NOAC and 58 patients were not on anticoagulation. There were 18 occurrences of VTE, of which 9 were on initial inpatient admission. These 9 patients were not included in the subsequent analysis. Among the non- VTE and VTE groups difference in age, sex, race, body mass index, Padua scores, or the co-morbidities were not statistically significant. The mean day to event was 9.78 days from admission and the mean day from a positive COVID PCR was 16 days. Of the 9 in hospital VTE events, 8 (89%) patients were on VTE prophylaxis with daily low molecular weight Heparin (LMWH), 1 patient was not on any anticoagulation. One patient was on NOAC however this was held on admission and in substitution was placed on LMWH. PE and DVT were diagnosed in 5 patients [56%] and 4 [44%] respectively. Our study did not find a statistically significant association between ICU admission, BMI or Padua scores and VTE.
CONCLUSIONS: The exaggerated inflammatory response that is associated with COVID-19 has been implicated in the development of a hypercoagulable state leading to both venous and arterial thrombi. Although a total of 18 patients had VTE, 9 of them were on admission and therefore not on any anticoagulation. The VTE rate in patients on prophylactic chemoprophylaxis, which in our institution is LWMH or heparin was 2.2%. This is in disagreement with the previously report rates. Additionally, this low incidence (N=9) was likely the reason we did not find a statistically significant association between the above variables and VTE.
CLINICAL IMPLICATIONS: Chemoprophylaxis with prophylactic anticoagulants such as LMWH should be utilized in all Covid 19 patients as it is effective in preventing VTE.
DISCLOSURES: No relevant relationships by Firas Abdulmajeed, source=Web Response
No relevant relationships by Abdelrhman Abo-zed, source=Web Response
No relevant relationships by Abasin Amanzai, source=Web Response
No relevant relationships by Amerpreet Brar, source=Web Response
No relevant relationships by Jamil Masood, source=Web Response
No relevant relationships by NIRZARI PANDYA, source=Web Response
No relevant relationships by Aaron Walker, source=Web Response
© 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.