Advertisement

INCIDENCE AND OUTCOME OF THROMBOTIC COMPLICATIONS IN PATIENTS WITH COVID-19 (SARS-COV-2) INFECTION: A SINGLE CENTER STUDY

      TOPIC: Pulmonary Vascular Disease
      TYPE: Original Investigations
      PURPOSE: To ascertain the incidence and outcomes of thrombotic complications in patients with coronavirus disease 2019 (COVID 19) admitted to a tertiary care, community based academic center.
      METHODS: This was a single center, retrospective observational study at Saint Barnabas Medical Center. Electronic medical record was screened from March 1, 2020 to May 31, 2020 for all adult patients (age > 18) with nasopharyngeal swab positive for SARS-CoV-2 PCR and a new, confirmed, diagnosis of deep vein thrombosis (DVT), pulmonary embolism (PE), or cerebrovascular accident (CVA). Patients with previous history of DVT/PE, family history of thrombotic disease or prior anticoagulation were excluded from the study. Demographics, comorbid conditions, laboratory values and outcomes (need for ICU admission, mechanical ventilation, overall length of stay and inpatient mortality) were also collected.
      RESULTS: A total of 1404 COVID-19 patients were included our study, and of those, 74 (5.3%) patients had confirmed DVT, PE and/or CVA. The mean age was 62.2 years with male predominance (44/74 patients, 59.5%). The mean BMI of the patients was 31.3 with HTN in 44 (59.45%), DM in 24 (32.4%), Cancer in 9 (12.2%), and CKD in 11 (14.9%). 36 (48.6%) patients had only DVT, 32 (43.2%) patients had only PE, 5 (6.8%) patients had both DVT and PE and only 1 (1.4%) patient had an ischemic stroke. These patients were further divided based on D-dimer levels (<500, 500-5000, 5001-10,000, >10,000). Mean D-dimer was 11,086.78 ng/ml. 8/74 (10.8%) patients had D-dimer < 500, 30/74 (40.5%) between 500-5000, 11/74 (14.9%) between 5001-10,000, and 20/74 (27%) had a D-dimer >10,000. 18/74 (24.3%) of the patients required mechanical ventilation and ICU admission. Average hospital length of stay was 15.8 days and average ICU length of stay was 12.3 days. In hospital COVID-19 mortality in VTE positive patients was 20.3% compared to 28.3% in VTE negative patients.
      CONCLUSIONS: At Saint Barnabas, the incidence rate of thrombotic complications in COVID-19 patients was 5.27% as is also evidenced by some recent studies (5%-8%). At the onset of the pandemic, studies showed an incidence rate of VTE 15-25% as compared to the overall rate of VTE in hospitalized patients pre-pandemic of 5.9 in 1000 patients. Larger studies are needed to compare clearly identify risk factors and outcomes associated with VTE in COVID patients.
      CLINICAL IMPLICATIONS: Hypercoagulability is a rising concern in COVID-19 patients and the decision to anticoagulate prophylactically or therapeutically has been challenging. A better understanding of the incidence of thrombotic complications and their risk factors is necessary for appropriate treatment to prevent morbidity and mortality.
      DISCLOSURES: No relevant relationships by Anvitha Ankireddypalli, source=Web Response
      No relevant relationships by Mehak Laharwal, source=Web Response
      No relevant relationships by Nirav Mistry, source=Web Response
      No relevant relationships by Aditi Saha, source=Web Response
      No relevant relationships by Sohaib Tariq, source=Web Response
      No relevant relationships by Lalithaa Thirunavukarasu Murugan, source=Web Response