Systemic thrombosis in a large cohort of COVID-19 patients despite thromboprophylaxis: A retrospective study.

Autor: Muñoz-Rivas N; Internal Medicine Department, Infanta Leonor University Hospital, Spain., Abad-Motos A; Anesthesiology Department, Infanta Leonor University Hospital, Spain., Mestre-Gómez B; Internal Medicine Department, Infanta Leonor University Hospital, Spain., Sierra-Hidalgo F; Neurology Department, Infanta Leonor University Hospital, Spain., Cortina-Camarero C; Cardiology Department, Infanta Leonor University Hospital, Spain., Lorente-Ramos RM; Radiology Department, Infanta Leonor University Hospital, Spain., Torres-Rubio P; Radiology Department, Infanta Leonor University Hospital, Spain., Arranz-García P; Administration Department, Infanta Leonor University Hospital, Spain., Franco-Moreno AI; Internal Medicine Department, Infanta Leonor University Hospital, Spain., Gómez-Mariscal E; Cardiology Department, Infanta Leonor University Hospital, Spain., Mauleón-Fernández C; Dermatology Department, Infanta Leonor University Hospital, Spain., Alonso-García S; Pathology Department, Infanta Leonor University Hospital, Spain., Rogado J; Medical Oncology Department, Infanta Leonor University Hospital, Spain., Saez-Vaquero T; Internal Medicine Department, Infanta Leonor University Hospital, Spain., Such-Diaz A; Department of Hospital Pharmacy, Infanta Leonor University Hospital, Spain., Ryan P; Internal Medicine Department, Infanta Leonor University Hospital, Spain., Moya-Mateo E; Internal Medicine Department, Infanta Leonor University Hospital, Spain., Martín-Navarro JA; Nephrology Department, Infanta Leonor University Hospital, Spain., Hernández-Rivas JA; Hematology and Haemostasis Department, Infanta Leonor University Hospital, Spain; Universidad Complutense de Madrid, Spain., Torres-Macho J; Internal Medicine Department, Infanta Leonor University Hospital, Spain; Universidad Complutense de Madrid, Spain., Churruca J; Hematology and Haemostasis Department, Infanta Leonor University Hospital, Spain. Electronic address: juan.churruca@salud.madrid.org.
Jazyk: angličtina
Zdroj: Thrombosis research [Thromb Res] 2021 Mar; Vol. 199, pp. 132-142. Date of Electronic Publication: 2021 Jan 07.
DOI: 10.1016/j.thromres.2020.12.024
Abstrakt: Background: Incidence of thrombotic events associated to Coronavirus disease-2019 (COVID-19) is difficult to assess and reported rates differ significantly. Optimal thromboprophylaxis is unclear.
Objectives: We aimed to analyze the characteristics of patients with a confirmed thrombotic complication including inflammatory and hemostatic parameters, compare patients affected by arterial vs venous events and examine differences between survivors and non-survivors. We reviewed compliance with thromboprophylaxis and explored how the implementation of a severity-adjusted protocol could have influenced outcome.
Methods: Single-cohort retrospective study of COVID-19 patients admitted, from March 3 to May 3 2020, to the Infanta Leonor University Hospital in Madrid, epicenter of the Spanish outbreak.
Results: Among 1127 patients, 80 thrombotic events were diagnosed in 69 patients (6.1% of the entire cohort). Forty-three patients (62%) suffered venous thromboembolism, 18 (26%) arterial episodes and 6 (9%) concurrent venous and arterial thrombosis. Most patients (90%) with a confirmed thrombotic complication where under low-molecular-weight heparin treatment. Overt disseminated intravascular coagulation (DIC) was rare. Initial ISTH DIC score and pre-event CRP were significantly higher among non-survivors. In multivariate analysis, arterial localization was an independent predictor of mortality (OR = 18, 95% CI: 2.4-142, p < .05).
Conclusions: Despite quasi-universal thromboprophylaxis, COVID-19 lead to a myriad of arterial and venous thrombotic events. Considering the subgroup of patients with thrombotic episodes, arterial events appeared earlier in the course of disease and conferred very poor prognosis, and an ISTH DIC score ≥ 3 at presentation was identified as a potential predictor of mortality. Severity-adjusted thromboprophylaxis seemed to decrease the number of events and could have influenced mortality. Randomized controlled trials are eagerly awaited.
(Copyright © 2021 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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