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

Corrado Lodigiani, Giacomo Iapichino, Luca Carenzo, Maurizio Cecconi, Paola Ferrazzi, Tim Sebastian, Nils Kucher, Jan-Dirk Studt, Clara Sacco, Alexia Bertuzzi, Maria Teresa Sandri, Stefano Barco, Humanitas COVID-19 Task Force, Corrado Lodigiani, Giacomo Iapichino, Luca Carenzo, Maurizio Cecconi, Paola Ferrazzi, Tim Sebastian, Nils Kucher, Jan-Dirk Studt, Clara Sacco, Alexia Bertuzzi, Maria Teresa Sandri, Stefano Barco, Humanitas COVID-19 Task Force

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.

Keywords: COVID-19; Cardiovascular complications; Disseminated intravascular coagulation; Mortality; SARS-CoV2; Venous thromboembolism.

Conflict of interest statement

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.

Figures

Fig. 1
Fig. 1
Probability of in-hospital death across age. We performed logistic regression to ascertain the effects of age on the likelihood that patients died during hospitalization (Odds Ratio 1.10; 95%CI 1.07–1.13). The figure depicts the probability of in-hospital death across age. The analysis was restricted to closed cases (dead or discharged at the time of analysis).

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