COVID‐19 and venous thromboembolism in intensive care or medical ward

Avruscio, Giampiero; Camporese, Giuseppe; Campello, Elena; Bernardi, Enrico; Persona, Paolo; Passarella, Christian; Noventa, Franco; Cola, Marco; Navalesi, Paolo; Cattelan, Annamaria; Tiberio, Ivo; Boscolo, Annalisa; Spiezia, Luca; Simioni, Paolo

Despite thromboprophylaxis, patients with coronavirus‐19 disease (COVID‐19) exhibit hypercoagulability and higher venous thromboembolic risk, although its real incidence is still unknown. The aim of the study was to evaluate the incidence of venous thromboembolism in COVID‐19 patients admitted to both intensive care unit and medical ward. Consecutive patients admitted for COVID‐19 to medical ward and intensive care unit at Padua University Hospital, all receiving thromboprophylaxis, underwent systematic ultrasonography of internal jugular, upper and lower limbs veins every 7(±1) days after the admission; and if negative, once‐weekly until discharge or death. In case of suspected pulmonary embolism, a multi‐detector computed tomographic angiography was performed. The primary outcome was the proportion of any deep‐vein thrombosis and symptomatic pulmonary embolism in both groups. An extended blood coagulative test was performed as well. From March 4 to April 30, 2020 a total of 85 patients were investigated, 44 (52%) in medical ward and 41 (48%) in intensive care unit. Despite thromboprophylaxis, venous thromboembolism occurred in 12 medical ward (27.3%) and 31 intensive care unit patients (75.6%) with an Odds Ratio of 9.3 (95%CI, 3.5 to 24.5;p<0.001). Multiple‐site deep‐vein thrombosis occurred in 55.6% of patients (95%CI, 39.6 to 70.5). Increased D‐Dimer levels significantly correlated with venous thromboembolism (p=0.001) and death (p=0.015). Summarizing, COVID‐19 patients admitted to medical ward or intensive care unit showed a high frequency of venous thromboembolism, despite standard‐ or high‐dose thromboprophylaxis. Whether thrombosis, particularly asymptomatic events, may play a role in the morbidity and mortality of COVID‐19 patients remain to be clarified.