Deep Vein Thrombosis in Hospitalized Patients with Coronavirus Disease 2019 (COVID-19) in Wuhan, China: Prevalence, Risk Factors, and Outcome.
Circulation. 2020 May 18;:
Authors: Zhang L, Feng X, Zhang D, Jiang C, Mei H, Wang J, Zhang C, Li H, Xia X, Kong S, Liao J, Jia H, Pang X, Song Y, Tian Y, Wang B, Wu C, Yuan H, Zhang Y, Li Y, Sun W, Zhang Y, Zhu S, Wang S, Xie Y, Ge S, Zhang L, Hu Y, Xie M
Background: To investigate deep vein thrombosis (DVT) in hospitalized patients with coronavirus disease 2019 (COVID-19), we performed a single institutional study to evaluate its prevalence, risk factors, prognosis, and potential thromboprophylaxis strategies in a large referral and treatment center. Methods: We studied a total of 143 patients with COVID-19 from January 29 to February 29, 2020. Demographic and clinical data, laboratory data, including ultrasound scans of the lower extremities, and outcome variables were obtained, comparisons were made between DVT and non-DVT groups. Results: Of the 143 patients hospitalized with COVID-19 (aged 63 ± 14 years; 74 [51.7%] man), 66 patients developed lower extremity DVT (46.1%, included 23 [34.8%] with proximal DVT and 43 [65.2%] with distal DVT).Compared with patients who with no DVT, patients with DVT were older and had a lower oxygenation index, a higher rate of cardiac injury, and worse prognosis including an increased proportion of deaths (23 [34.8%] vs 9 [11.7%], P = 0.001) and a decreased proportion of patients discharged (32 [48.5%] vs 60 [77.9%], P < 0.001). Multivariant analysis only showed an association between CURB-65 score 3-5 (OR = 6.122, P = 0.031), Padua prediction score ≥ 4 (OR = 4.016, P = 0.04), and D-dimer >1.0 (μg/ml) (OR = 5.818, P < 0.014) and DVT in this cohort, respectively. The combination of a CURB-65 score 3-5, a Padua prediction score ≥ 4, and D-dimer > 1.0 (μg/ml) has a sensitivity of 88.52% and a specificity of 61.43% for screening for DVT. In the subgroup of patients with a Padua prediction score ≥ 4 and whose ultrasound scans were performed ˃72 hours after admission, DVT was present in 18 (34.0%) of the subgroup receiving venous thromboembolism prophylaxis vs 35 (63.3%) in the nonprophylaxis group (P = 0.010). Conclusions: The prevalence of DVT is high and is associated with adverse outcomes in hospitalized patients with COVID-19. Prophylaxis for venous thromboembolism may be protective in patients with a Padua protection score ≥ 4 after admission. Our data seem to suggest that COVID-19 is probably an additional risk factor for DVT in the hospitalized patients.
PMID: 32421381 [PubMed - as supplied by publisher]