Risk assessment of venous thromboembolism and bleeding in COVID-19 patients

Lan Wang, Lan Zhao, Feng Li, Ji Liu, Li Zhang, Qiuhong Li, Jin Gu, Shuo Liang, Qinhua Zhao, Jinmin Liu, Jin-Fu Xu, Lan Wang, Lan Zhao, Feng Li, Ji Liu, Li Zhang, Qiuhong Li, Jin Gu, Shuo Liang, Qinhua Zhao, Jinmin Liu, Jin-Fu Xu

Abstract

Background: The coronavirus disease 2019 (COVID-19) is a newly recognized illness that has spread rapidly all over the world. More and more reports highlight the risk of venous thromboembolism (VTE) in COVID-19. Our study aims to identify in-hospital VTE risk and bleeding risk in COVID-19 patients.

Methods: We retrospectively studied 138 consecutively enrolled patients with COVID-19 and identified in-hospital VTE and bleeding risk by Padua Prediction Score and Improve bleed risk assessment model. The clinical data and features were analyzed in VTE patients.

Results: Our findings identified that 23 (16.7%) patients with COVID-19 were at high risk for VTE according to Padua prediction score and 9 (6.5%) patients were at high risk of bleeding for VTE prophylaxis according to Improve prediction score. Fifteen critically ill patients faced double high risk from thrombosis (Padua score more than 4 points in all 15 [100%] patients) and hemorrhage (Improve score more than 7 points in 9 [60.0%] patients). Thrombotic events were identified in four patients (2.9%) of all COVID-19 patients. All of them were diagnosed with deep vein thrombosis by ultrasound 3 to 18 days after admission. Three (75.0%) were critically ill patients, which means that the incidence of VTE among critically ill patients was 20%. One major hemorrhage happened in critically ill patients during VTE treatment.

Conclusion: Critically ill patients with COVID-19 suffered both a high risk of thrombosis and bleeding risks. More effective VTE prevention strategies based on an individual assessment of bleeding risks were necessary for critically ill patients with COVID-19.

Keywords: Padua prediction score; coronavirus disease 2019; deep vein thrombosis; improve bleed risk assessment model; venous thromboembolism.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022 The Authors. The Clinical Respiratory Journal published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Distribution of patients and Padua scores
FIGURE 2
FIGURE 2
Distribution of patients and Improve scores

References

    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan. China Lancet. 2020;395(10223):497‐506.
    1. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507‐513.
    1. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727‐733.
    1. Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020;382(10):929‐936.
    1. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS‐CoV‐2 pneumonia in Wuhan, China: a single‐centered, retrospective, observational study. Lancet. Respir Med. 2020;8(5):475‐481.
    1. Streiff MB, Agnelli G, Connors JM, et al. Guidance for the treatment of deep vein thrombosis and pulmonary embolism. J Thromb Thrombolysis. 2016;41(1):32‐67.
    1. Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I9‐I16.
    1. WHO . Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. 2020. Jan 11, 2020.
    1. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus‐infected pneumonia in Wuhan, China. Jama. 2020;323(11):1061‐1069.
    1. Barbar S, Noventa F, Rossetto V, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010;8(11):2450‐2457.
    1. Decousus H, Tapson VF, Bergmann JF, et al. Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. Chest. 2011;139(1):69‐79.
    1. Wang T, Chen R, Liu C, et al. Attention should be paid to venous thromboembolism prophylaxis in the management of COVID‐19. Lancet Haematol. 2020;7(5):e362‐e363.
    1. Klok FA, Kruip M, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID‐19. Thromb Res. 2020;191:145‐147.
    1. Lodigiani C, Iapichino G, Carenzo L, et al. Venous and arterial thromboembolic complications in COVID‐19 patients admitted to an academic hospital in Milan. Italy Thromb Res. 2020;191:9‐14.
    1. Zeng DX, Xu JL, Mao QX, et al. Association of Padua prediction score with in‐hospital prognosis in COVID‐19 patients. QJM. 2020;113(11):789‐793.
    1. Klok FA, Barco S, Turpie AGG, et al. Predictive value of venous thromboembolism (VTE)‐BLEED to predict major bleeding and other adverse events in a practice‐based cohort of patients with VTE: results of the XALIA study. Br J Haematol. 2018;183(3):457‐465.
    1. Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378(21):1965‐1975.
    1. Kaplan D, Casper TC, Elliott CG, et al. VTE incidence and risk factors in patients with severe sepsis and septic shock. Chest. 2015;148(5):1224‐1230.
    1. Cook D, Attia J, Weaver B, McDonald E, Meade M, Crowther M. Venous thromboembolic disease: an observational study in medical‐surgical intensive care unit patients. J Crit Care. 2000;15(4):127‐132.
    1. Cook D, Crowther M, Meade M, et al. Deep venous thrombosis in medical‐surgical critically ill patients: prevalence, incidence, and risk factors. Crit Care Med. 2005;33(7):1565‐1571.
    1. Wells PS, Forgie MA, Rodger MA. Treatment of venous thromboembolism. Jama. 2014;311(7):717‐728.
    1. Sy E, Sklar MC, Lequier L, Fan E, Kanji HD. Anticoagulation practices and the prevalence of major bleeding, thromboembolic events, and mortality in venoarterial extracorporeal membrane oxygenation: a systematic review and meta‐analysis. J Crit Care. 2017;39:87‐96.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere