COVID-19 research briefs: High incidence of thrombotic events in patients hospitalized with COVID-19

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Published: 2020-10-18 © 2020 John Wiley & Sons, Inc.

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Clinical question
Does COVID-19 increase the risk of thromboembolic events in high-risk patients?

Bottom line
Retrospective data suggests a high incidence of thrombotic events in hospitalized COVID-19 patients, particularly in patients with risk factors. (LOE = 2c)

Reference
Bilaloglu S, Aphinyanaphongs Y, Jones S, Iturrate E, Hochman J, Berger JS. Thrombosis in hospitalized patients with COVID-19 in a New York City health system. JAMA 2020;324(8):799-801.

Study design: Not applicable

Setting: Population-based

Synopsis
Research Brief #58: This study reports a consecutive series of 3334 patients with COVID-19 who were hospitalized between March 1 and April 17, 2020, at NYU Langone Health Center: 829 were in the intensive care unit (ICU) and 2505 were not in the ICU. During this period, most patients received thromboprophylaxis. The authors used medical record review, including natural language processing to identify episodes of thrombosis. Rates of pulmonary embolism were 6.2% in the ICU and 2.2% on the ward; rates of deep vein thrombosis were 9.4% in the ICU and 2.0% on the ward. Rates of stroke were 3.7% in the ICU and 0.9% on the ward, and rates for myocardial infarction were 13.9% in the ICU and 7.3% on the ward. All-cause mortality was significantly higher in those with thrombosis (43.2% vs 21.0%; number needed to treat = 5). Factors associated with thrombosis included increasing age, self-identified Hispanic ethnicity, underlying coronary artery disease, and increasing D-dimer levels on admission. Although there is no comparison with non–COVID-19 patients, the authors argue that these rates are higher than with other respiratory infections, such as influenza. These findings are consistent with other studies and reinforce the value of measuring D-dimer levels on admission (it's an independent risk factor for mortality), to strongly consider a low-dose anticoagulant for all patients without a contraindication, and to be vigilant for thrombotic complications.

Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA

Copyright © 2020 John Wiley & Sons, Inc.