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VOLUME 27 , ISSUE 11 ( November, 2023 ) > List of Articles

Original Article

Incidence and Risk Factors Associated with Thromboembolic Events among Patients with COVID-19 Inpatients: A Retrospective Study

Wail Abdulhafez Tashkandi

Keywords : Coronavirus disease-2019, Severe acute respiratory syndrome coronavirus 2, Thromboembolic events, Thrombotic events, Vascular thromboembolism

Citation Information : Tashkandi WA. Incidence and Risk Factors Associated with Thromboembolic Events among Patients with COVID-19 Inpatients: A Retrospective Study. Indian J Crit Care Med 2023; 27 (11):830-836.

DOI: 10.5005/jp-journals-10071-24575

License: CC BY-NC 4.0

Published Online: 30-10-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aims and objectives: Despite thromboprophylaxis, some severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients develop thrombotic complications with poor prognosis. Our goal is to comprehensively assess the incidence, risk factors, and clinical outcomes associated with thromboembolic events (TE) among adult patients presenting with coronavirus disease-2019 (COVID-19). Materials and methods: The study was conducted as an observational and retrospective study across COVID-19 patients (n = 207) in a tertiary care hospital in the Middle East and North Africa (MENA) region. Electronic health records were collected from the COVID-19 Database from April 2020 to December 2020 which included clinical history and TE. Results: Fifty-six (27.05%) out of 207 patients (age: 54.42 ± 15.01 years) developed TE despite the anticoagulant therapy. The incidence of venous thromboembolism (VTE) was significantly higher for patients aged >50 years compared to <50 years (73.21% vs 26.79%, p < 0.05). There were no differences in the incidence of VTE between genders (p = 0.561). 165 patients (79.71%) received anticoagulant therapy, yet 48 (29%) developed TE. The most commonly used anticoagulant was low-molecular-weight heparin (LMWH, 47.34%). In spite of efficient treatment and medical management, the majority of patients with TE (45 out of 56 patients, 80.35%) experienced mortality. The comorbidities that significantly increase the risk of TE include hypertension (HTN) and ischemic heart disease (IHD). The laboratory parameters that were associated with an increased risk of VTE include ferritin, lactate dehydrogenase (LDH), and creatinine. Conclusion: The COVID-19 patients develop thrombotic complications. Future studies should clarify the underlying mechanisms of TE and optimize the antithrombotic regimens in COVID-19 patients.

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  1. Giusti B, Gori AM, Alessi M, Rogolino A, Lotti E, Poli D, et al. SARS-CoV-2 Induced coagulopathy and prognosis in hospitalized patients: A snapshot from Italy. Thromb Haemost 2020:120:1233–1236. DOI: 10.1055/s-0040-1712918.
  2. Arachchillage DR, Laffan M. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020;18(5):1233. DOI: 10.1111/jth.14768.
  3. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020;18(4):844–847. DOI: 10.1111/jth.14820.
  4. Llitjos JF, Leclerc M, Chochois C, Monsallier JM, Ramakers M, Auvray M, et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. J Thromb Haemost 2020;18(7):1743–1746. DOI: 10.1111/jth.14869.
  5. Middeldorp S, Coppens M, van Haaps TF, Foppen M, Vlaar AP, Müller MCA, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost 2020;18(8):1995–2002. DOI: 10.1111/jth.14888.
  6. Suh YJ, Hong H, Ohana M, Bompard F, Revel MP, Valle C, et al. Pulmonary embolism and deep vein thrombosis in COVID-19: A systematic review and meta-analysis. Radiology 2021;298(2):E70–E80. DOI: 10.1148/radiol.2020203557.
  7. Bowles L, Platton S, Yartey N, Dave M, Lee K, Hart DP, et al. Lupus anticoagulant and abnormal coagulation tests in patients with COVID-19. N Engl J Med 2020;383(3):288–290. DOI: 10.1056/nejmc2013656.
  8. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020;135(23):2033–2040. DOI: 10.1182/blood.2020006000.
  9. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020;395(10229): 1054–1062. DOI: 10.1016/s0140-6736(20)30566-3.
  10. Crayne CB, Albeituni S, Nichols KE, Cron RQ. The immunology of macrophage activation syndrome. Front Immunol 2019;10:119. DOI: 10.3389/fimmu.2019.00119.
  11. Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunologic features in severe and moderate coronavirus disease 2019. J Clin Invest 2020;130(5):2620–2629. DOI: 10.1172/jci137244.
  12. Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): A meta-analysis. Clin Chem Lab Med 2020, 58(7):1021–1028. DOI: 10.1515/cclm-2020-0369.
  13. Giamarellos–Bourboulis EJ, Netea MG, Rovina N, Akinosoglou K, Antoniadou A, Antonakos N, et al. Complex immune dysregulation in COVID-19 patients with severe respiratory failure. Cell Host Microbe 2020;27(6):992–1000. DOI: 10.1016/j.chom.2020.04.009.
  14. Grimmer B, Kuebler WM. The endothelium in hypoxic pulmonary vasoconstriction. J Appl Physiol 2017;123(6):1635–1646. DOI: 10.1152/japplphysiol.00120.2017.
  15. Gupta N, Zhao YY, Evans CE. The stimulation of thrombosis by hypoxia. Thromb Res 2019;181:77–83. DOI: 10.1016/j.thromres.2019.07.013.
  16. Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: A multicenter prospective cohort study. Intensive Care Med 2020;46(6):1089–1098. DOI: 10.1007/s00134-020-06062-x.
  17. Cai C, Guo Y, You Y, Hu K, Cai F, Xie M, et al. Deep venous thrombosis in COVID-19 patients: A cohort analysis. Clin Applied Thromb Hemost 2020;26:1076029620982669. DOI: 10.1177/1076029620982669.
  18. Malas MB, Naazie IN, Elsayed N, Mathlouthi A, Marmor R, Clary B. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis. EClinicalMedicine 2020;29:100639. DOI: 10.1016/j.eclinm.2020.100639.
  19. De Lorenzo A, Estato V, Castro–Faria–Neto HC, Tibirica E. Obesity-related inflammation and endothelial dysfunction in COVID-19: Impact on disease severity. J Inflamm Res 2021;14:2267–2276. DOI: 10.2147/jir.s282710.
  20. Alonso–Fernández A, Toledo–Pons N, Cosío BG, Millán A, Calvo N, Ramón L, et al. Prevalence of pulmonary embolism in patients with COVID-19 pneumonia and high D-dimer values: A prospective study. PloS One 2020;15(8):e0238216. DOI: 10.1371/journal.pone.0238216.
  21. Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020;191:145–147. DOI: 10.1016/j.thromres.2020.04.013.
  22. Mansory EM, Srigunapalan S, Lazo–Langner A. Venous thromboembolism in hospitalized critical and noncritical COVID-19 patients: A systematic review and meta-analysis. TH Open 2021; 5(3):e286–e294. DOI: 10.1055/s-0041-1730967.
  23. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020;5(7):811–818. DOI: 10.1001/jamacardio.2020.1017.
  24. Yin S, Huang M, Li D, Tang N. Difference of coagulation features between severe pneumonia induced by SARS-CoV-2 and non-SARS-CoV-2. J Thromb Thrombolysis 2021;51(4):1107–1110. DOI: 10.1007/s11239-020-02105-8.
  25. Ciceri F, Beretta L, Scandroglio AM, Colombo S, Landoni G, Ruggeri A, et al. Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): An atypical acute respiratory distress syndrome working hypothesis. Crit Care Resusc 2020;22(2):95–97. PMID: 32294809.
  26. Gülcü O, Aksakal E, Aydemir S, Doğan R, Saraç I, Aydın SS, et al. Association between previous anticoagulant use and mortality among hospitalized patients with COVID-19. J Thromb Thrombolysis 2022;53(1):88–95. DOI: 10.1007/s11239-021-02489-1.
  27. Haybar H, Maniati M, Saki N, Zayeri ZD. COVID-19: Imbalance of multiple systems during infection and importance of therapeutic choice and dosing of cardiac and anticoagulant therapies. Mol Biol Rep 2021;48(3):2917–2928. DOI: 10.1007/s11033-021- 06333-w.
  28. Kamel AM, Sobhy M, Magdy N, Sabry N, Farid S. Anticoagulation outcomes in hospitalized COVID-19 patients: A systematic review and meta-analysis of case–control and cohort studies. Rev Med Virol 2021;31(3):e2180. DOI: 10.1002/rmv.2180.
  29. Flumignan RL, Tinôco JDS, Pascoal PI, Areias LL, Cossi MS, Fernandes MI, et al. Prophylactic anticoagulants for people hospitalized with COVID-19: Systematic review. Br J Surg 2021;108(9):e299–e300. DOI: 10.1093/bjs/znab197.
  30. Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, 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. DOI: 10.1016/j.thromres.2020.04.024.
  31. Mennuni MG, Renda G, Grisafi L, Rognoni A, Colombo C, Lio V, et al. Clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for COVID-19. J Thromb Thrombolysis 2021;52(3):782–790. DOI: 10.1007/s11239-021-02401-x.
  32. Rostami M, Mansouritorghabeh H. D-dimer level in COVID-19 infection: A systematic review. Expert Rev Hematol 2020;13(11): 1265–1275. DOI: 10.1080/17474086.2020.1831383.
  33. Shi C, Wang C, Wang H, Yang C, Cai F, Zeng F, et al. The potential of low molecular weight heparin to mitigate cytokine storm in severe COVID-19 patients: A retrospective cohort study. Clin Transl Sci 2020;13(6):1087–1095. DOI: 10.1111/cts.12880.
  34. Zhang Y, Xiao M, Zhang S, Xia P, Cao W, Jiang W, et al. Coagulopathy and antiphospholipid antibodies in patients with COVID-19. N Engl J Med 2020;382:e38. DOI: 10.1056/nejmc2007575.
  35. Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost 2020;18(6):1421–1424. DOI: 10.1111/jth.14830.
  36. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis 2020:71(15):762–728. DOI: 10.1093/cid/ciaa248.
  37. de la Rica R, Borges M, Gonzalez–Freire M. COVID-19: In the eye of the cytokine storm. Front Immunol 2020;11:558898. DOI: 10.3389/fimmu.2020.558898.
  38. Brosnahan SB, Smilowitz NR, Amoroso NE, Barfield M, Berger JS, Goldenberg R, et al. Thrombosis at hospital presentation in patients with and without coronavirus disease 2019. J Vasc Surg Venous Lymphat 2021;9:845–852. DOI: 10.1016/j.jvsv.2020.11.004.
  39. Spyropoulos AC, Levy JH, Ageno W, Connors JM, Hunt BJ, Iba T, et al. Scientific and standardization committee communication: Clinical guidance on the diagnosis, prevention, and treatment of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost 2020;18(8):1859–1865. DOI: 10.1111/jth.14929.
  40. Voicu S, Bonnin P, Stépanian A, Chousterman BG, Gall AL, Malissin I. High prevalence of deep vein thrombosis in mechanically ventilated COVID-19 patients. J Am Coll Cardiol 2020;76(4):480–482. DOI: 10.1016/j.jacc.2020.05.053.
  41. Talwar D, Kumar S, Acharya S, Raisinghani N, Madaan S, Hulkoti V, et al. Interleukin 6 and its correlation with COVID-19 in terms of outcomes in an intensive care unit of a rural hospital: A cross-sectional study. Indian J Crit Care Med 2022;26(1):39–42. DOI: 10.5005/jp-journals-10071-24075.
  42. Kerai S, Singh R, Saxena KN, Desai SD, Bhalotra AR. A retrospective study on experience of high-flow nasal cannula oxygen in critically ill COVID-19 adult patients admitted to intensive care unit. Indian J Crit Care Med 2022;26(1):62–66. DOI: 10.5005/jp-journals-10071-24097.
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