COVID-19 Associated Venous Thromboembolism Portends Worse Survival

Meena, Richard A.; Sharifpour, Milad; Gaddh, Manila; Cui, Xiangqin; Xie, Yue; Di, Mengyu; Brewster, Luke P.; Duwayri, Yazan; Alabi, Olamide

Background: Patients with Coronavirus Disease 2019 (COVID-19) seem to be at high risk for venous thromboembolism (VTE) development, but there is a paucity of data exploring both the natural history of COVID-19 associated VTE and the risk for poor outcomes after VTE development. This investigation aims to explore the relationship between COVID-19 associated VTE development and mortality. Methods: A prospectively maintained registry of patients over 18 years of age admitted for COVID-19 related illnesses within an academic healthcare network between March and September 2020 was reviewed. Codes from the tenth revision of the International Classification of Diseases (ICD-10) for VTE were collected. The charts of those patients with an ICD-10 code for VTE were manually reviewed to confirm VTE diagnosis. Results: 2552 patients were admitted with COVID-19 related illnesses. 126 (4.9%) patients developed a VTE. A disproportionate percentage of patients of Black race developed a VTE (70.9% VTE versus 57.8% non-VTE, p=0.012). A higher proportion of patients with VTE expired during their index hospitalization (22.8% VTE versus 8.4% non-VTE, p<0.001). On multivariable logistic regression analysis, VTE was independently associated with mortality (OR 3.17; 95% CI, 1.9 to 5.2; p<0.001). Hispanic/Latinx ethnicity was associated with decreased mortality (OR 0.45; 95% CI, 0.21 to 1.00; p=0.049). Discussion: Hospitalized patients of Black race with COVID-19 were more prone to VTE development, and patients with COVID-19 who developed in-hospital VTE roughly nearly threefold higher odds of mortality. Further emphasis should be placed on optimizing COVID-19 anticoagulation protocols to reduce mortality in this high-risk cohort.