J Vasc Surg Venous Lymphat Disord. 2021 Apr 6:S2213-333X(21)00175-X. doi: 10.1016/j.jvsv.2021.03.009. Online ahead of print.
OBJECTIVE: To assess the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) in hospitalized patients with coronavirus disease 2019 (COVID-19) in comparison with a matched cohort with similar cardiovascular risk factors, as well as the impact of DVT/PE on hospital course.
METHODS: A retrospective review of prospectively collected data on COVID-19 patients hospitalized from 03/11/2020 to 09/04/2020 was performed. Patients were randomly matched in a 1:1 ratio by age, sex, hospital of admission, smoking history, diabetes mellitus and coronary artery disease with a cohort of non-COVID-19 patients. The primary end point was incidence of DVT/PE and odds of developing DVT/PE using a conditional logistic regression model. The secondary end point was hospitalization outcomes in COVID-19 patients with and without DVT/PE, including mortality, intensive care unit (ICU) admission, ICU days and length of hospitalization (LOH). Multivariable regression analysis was performed to identify variables associated with mortality, ICU admission, discharge disposition, ICU days and LOH.
RESULTS: There were 13,310 patients with COVID-19 infection and 915 (6.9%) were hospitalized across our multi-site health care system. Mean age of the hospitalized patients was 60.8±17.0 years, 396 (43.3%) were female. There were 82 (9.0%) patients with DVT/PE diagnosis confirmed with ultrasound of the extremities and/or computed tomography angiography of the chest. Odds of presenting with DVT/PE in the setting of COVID-19 infection was higher than without COVID-19 infection (0.6% [5/915] vs. 9.0% [82/915]; OR 18; 95% CI [8.0-51.2], p<0.001). Vascular risk factors were no different among COVID-19 patients with and without DVT/PE. Mortality (p=0.02), the need for ICU care (p<0.001), duration of ICU stay (p<0.001) and LOH (p<0.001) were higher in the DVT/PE cohort than in those without DVT/PE. On multivariable logistic regression analysis, hemoglobin (Hb) (OR 0.71, 95% CI [0.46-0.95], p=0.04) and D-dimer (OR 1.0, 95% CI [0.33-1.56], p=0.03) levels were associated with higher mortality; activated partial thromboplastin time (aPTT) (OR 1.1, 95% CI [1.00-1.12], p=0.03) and interleukin-6 (IL-6) (OR 1.0, 95% CI [1.01-1.07], p=0.05) were associated with higher risk for ICU admission; IL-6 (OR 1.0, 95% CI [1.00-1.02], p=0.05) was associated with higher risk for rehabilitation placement after discharge. On multivariable gamma regression analysis, Hb (Coef -3.0, 95% CI [0.03-0.08], p=0.005) was associated with prolonged ICU stay; aPTT (Coef 2.0, 95% CI [0.003-0.006], p=0.05), international normalized ratio (INR) (Coef -3.2, 95% CI [0.06-0.19], p=0.002) and IL-6 (Coef 2.4, 95% CI [0.0011-0.0027], p=0.02) were associated with prolonged LOH.
CONCLUSION: There is a significantly higher incidence of DVT/PE in hospitalized COVID-19 positive patients compared with a non-COVID-19 cohort matched for cardiovascular risk factors. Patients affected by DVT/PE are more likely to have higher mortality, require ICU care, prolonged ICU days and LOH compared with COVID-19 positive patients without DVT/PE. Advancements in DVT/PE prevention are needed for patients hospitalized for COVID-19 infection.