Venous Thromboembolism in Hospitalized COVID-19 Patients Treated in a Single Academic Center in Mexico: A Case Series Study

Abstract

Background

The increasing prevalence of venous thromboembolism (VTE) among patients with coronavirus disease 2019 (COVID-19) is a matter of concern as it contributes significantly to patients' morbidity and mortality. Data regarding the optimal anticoagulation regimen for VTE prevention and treatment remain scarce. This study describes the characteristics, treatment, and outcomes of COVID-19 patients with VTE treated in a single academic center in Mexico.

Methods

We conducted a retrospective study of all patients with a positive PCR test for SARS-CoV-2 hospitalized in a single academic center in Monterrey, Mexico, between March 2020 and February 2021, with a radiologically confirmed VTE, including deep venous thrombosis (DVT) and pulmonary embolism (PE). Informed consent was obtained from each patient before reviewing their medical records.

Results

Of the 2000 COVID-19 hospitalized patients, 36 (1.8%) developed VTE and were included in the analysis. The median age was 60 years (range 32-88 years), and up to 78% (n = 28) were males. Most patients (n = 34, 94%) had an underlying comorbidity and 47% (n = 17) had a BMI ≥ 30 kg/m2. In most cases (n=28, 78%), VTE presented as a PE, whereas the remaining 22% (n = 8) had a DVT. The median time between hospital admission and VTE was 8 days (range 0-33 days). Regarding the thromboprophylaxis regimen, 35/36 patients received low molecular weight heparin enoxaparin on admission, most commonly at a dose of 60 mg daily (n = 19, 53%). Other complications presented were superinfection (n = 19, 53%), acute kidney injury (n = 11, 31%), and septic shock (n = 5, 14%). A total of 69% of patients (n = 25) required intensive care unit admission, and patients' overall mortality was 55.6%.

Conclusion

VTE remains a significant cause of increased morbidity and mortality among patients with COVID-19. The strikingly high mortality among patients with VTE highlights the need for further investigation regarding the best preventive, diagnostic, and treatment approaches.

Keywords

venous thromboembolism COVID-19 deep venous thrombosis pulmonary embolism

Get full access to this article

View all access options for this article.

References

JHU . COVID-19 dashboard by the center for systems science and engineering (CSSE) at johns hopkins university (JHU). https://coronavirus.jhu.edu/map.html. https://coronavirus.jhu.edu/map.html. Accessed May 24, 2021.

Zhou

Yang

Chi

, et al. Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: a systematic review and meta-analysis. Int J Infect Dis. 2020;99:47-56. doi:10.1016/j.ijid.2020.07.029.

Sridharan

Vegunta

Rokkam

VRP

, et al. Venous thromboembolism in hospitalized COVID-19 patients. Am J Therapeut. 2020;27(6):e599-e610. doi:10.1097/MJT.0000000000001295.

Mondal

Quintili

Karamchandani

Bose

. Thromboembolic disease in COVID-19 patients: a brief narrative review. J Intensive Care. 2020;8(1):70. doi:10.1186/s40560-020-00483-y.

Ozsu

Gunay

Konstantinides

. A review of venous thromboembolism in COVID‐19: a clinical perspective. Clin Respir J. 2021;15(5):506-512. doi:10.1111/crj.13330.

Malas

Naazie

Elsayed

Mathlouthi

Marmor

Clary

. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: a systematic review and meta-analysis. EClinicalMedicine. 2020;29-30:100639. doi:10.1016/j.eclinm.2020.100639.

Mohamed

MFH

Al-Shokri

Shunnar

, et al. Prevalence of venous thromboembolism in critically ill COVID-19 patients: systematic review and meta-analysis. Front Cardiovasc Med. 2021;7:598846. doi:10.3389/fcvm.2020.598846.

Dobesh

Trujillo

. Coagulopathy, venous thromboembolism, and anticoagulation in patients with COVID‐19. Pharmacotherapy. 2020;40(11):1130-1151. doi:10.1002/phar.2465.

Nougier

Benoit

Simon

, et al. Hypofibrinolytic state and high thrombin generation may play a major role in SARS‐COV2 associated thrombosis. J Thromb Haemost. 2020;18(9):2215-2219. doi:10.1111/jth.15016.

10.

Wang

Yin

, et al. Clinical characteristics and risk factors for symptomatic venous thromboembolism in hospitalized COVID‐19 patients: a multicenter retrospective study. J Thromb Haemos. 2021;19(4):1038-1048. doi:10.1111/jth.15261.

11.

Spyropoulos

Levy

Ageno

, 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.

12.

Arribalzaga

Martínez-Alfonzo

Díaz-Aizpún

, , et al. Incidence and clinical profile of venous thromboembolism in hospitalized COVID-19 patients from Madrid region. Thromb Res. 2021;203:93-100. doi:10.1016/j.thromres.2021.05.001.

13.

Singh

Gupta

Ghosh

Misra

. Diabetes in COVID-19: prevalence, pathophysiology, prognosis and practical considerations. Diabetes & Metabolic Syndrome: Clin Res Rev. 2020;14(4):303-310. doi:10.1016/j.dsx.2020.04.004.

14.

Huang

Lim

Pranata

. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia - a systematic review, meta-analysis, and meta-regression. Diabetes & Metabolic Syndrome: Clin Res Rev. 2020;14(4):395-403. doi:10.1016/j.dsx.2020.04.018.

15.

Wijaya

Andhika

Huang

. Hypercoagulable state in COVID-19 with diabetes mellitus and obesity: is therapeutic-dose or higher-dose anticoagulant thromboprophylaxis necessary? Diabetes & Metabolic Syndrome: Clin Res Rev. 2020;14(5):1241-1242. doi:10.1016/j.dsx.2020.07.015.

16.

Zhang

Feng

Zhang

, et al. Deep vein thrombosis in hospitalized patients with COVID-19 in wuhan, China. Circulation. 2020;142(2):114-128. doi:10.1161/CIRCULATIONAHA.120.046702.

17.

Helms

Tacquard

, 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.

18.

Zheng

Fan

, et al. Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study. BMJ. 2020;369:m1443. doi:10.1136/bmj.m1443.

19.

Fajnzylber

Regan

, et al. SARS-CoV-2 viral load is associated with increased disease severity and mortality. Nat Commun. 2020;11(1):5493. doi:10.1038/s41467-020-19057-5.

20.

Shi

Zhu

, et al. Association of viral load with serum biomakers among COVID-19 cases. Virology. 2020;546:122-126. doi:10.1016/j.virol.2020.04.011.

21.

Magleby

Westblade

Trzebucki

, et al. Impact of severe acute respiratory syndrome coronavirus 2 viral load on risk of intubation and mortality among hospitalized patients with coronavirus disease 2019. Clin Infect Dis 2020. doi:10.1093/cid/ciaa851.

22.

Lyman

Carrier

, et al. American society of hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Advances. 2021;5(4):927-974. doi:10.1182/bloodadvances.2020003442.

23.

Maldonado

Tao

Mackey

. Antithrombotic therapies in COVID-19 Disease: a systematic review. J Gen Intern Med. 2020;35(9):2698-2706. doi:10.1007/s11606-020-05906-y.

24.

Bikdeli

Madhavan

Jimenez

, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up. J Am Coll Cardiol. 2020;75(23):2950-2973. doi:10.1016/j.jacc.2020.04.031.

25.

Sakr

Giovini

Leone

, et al. Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review. Ann Intensive Care. 2020;10:124. doi:10.1186/s13613-020-00741-0.