Deep Vein Thrombosis in Hospitalized COVID-19 Patients

Aug 07, 2020
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Authors:
Zhang L, Feng X, Zhang D, et al.
Citation:
Deep Vein Thrombosis in Hospitalized Patients With COVID-19 in Wuhan, China: Prevalence, Risk Factors, and Outcome. Circulation 2020;142:114-128.
Summary By:
Geoffrey D. Barnes, MD, MSc, FACC

Quick Takes

  • Venous thromboembolism is a common complication of COVID-19, occurring in up to 46% of hospitalized patients.
  • Venous thromboembolism can occur despite the use of chemoprophylaxis.
  • Sicker patients with COVID-19 are at higher risk of developing deep vein thrombosis.

Study Questions:

What is the risk of deep vein thrombosis (DVT) among patients hospitalized with coronavirus disease 2019 (COVID-19)?

Methods:

The authors conducted a single-center study of 143 patients with COVID-19 admitted to the hospital in Wuhan, China, between January 29 and February 29, 2020. Primary outcome of interest was lower extremity DVT as diagnosed with ultrasound, which was performed routinely for all patients regardless of clinical symptoms.

Results:

Of the 143 patients hospitalized with COVID-19 (mean age 63 ± 14 years, 51.7% men), 66 (46.1%) patients developed lower extremity DVT. Of these, 23 (34.8%) were proximal DVT. Compared to patients who did not develop DVT, those with DVT had higher rates of cardiac injury, worse prognosis, and higher proportion of death (23/66 [34.8%] vs. 9/77 [11.7%], p = 0.001). Multivariable analysis showed an association between a CURB-65 score of 3-5 (odds ratio [OR], 6.122; p = 0.031), Padua score ≥4 (OR, 4.016; p = 0.04), D-dimer >1.0 μg/ml (OR, 5.818; p = 0.014), and development of DVT. DVT prophylaxis was given to a minority of patients (53 [37.1%]). DVT was commonly found even among patients in whom pharmacologic prophylaxis was being given (22/53 [41.5%]).

Conclusions:

The authors concluded that the prevalence of DVT is high and associated with adverse outcomes among patients hospitalized with COVID-19.

Perspective:

This single-center report from Wuhan, China, describes a high risk of venous thromboembolism (VTE) among patients hospitalized with COVID-19. High rates have been found in earlier reports from China as well as from Europe. However, some more recent US-based studies have described much lower rates of VTE. The discrepancy may be related to the use of systemic ultrasound screening in some of the Chinese and European studies, the lack of routine VTE prophylaxis in Asian populations, and the inclusion or exclusion of distal DVT. When only looking at proximal DVT, the event rate in this study is 16.1%, which is not significantly higher than other COVID-19 estimates or other studies of critically ill patients. Nonetheless, routine use of VTE prophylaxis is now standard practice and recommended by most guidelines and expert guidance documents.

Clinical Topics: Anticoagulation Management, COVID-19 Hub, Noninvasive Imaging, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Anticoagulation Management and Venothromboembolism, Echocardiography/Ultrasound

Keywords: Anticoagulants, Coronavirus, COVID-19, Critical Illness, Outcome Assessment, Health Care, Primary Prevention, Risk Factors, severe acute respiratory syndrome coronavirus 2, Ultrasonography, Vascular Diseases, Venous Thromboembolism, Venous Thrombosis


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