Abstract
Aim: Coronavirus disease 2019 (COVID-19) has been associated with increased mortality and morbidity from thromboembolism, especially venous thromboembolism. There are more limited data for systemic thromboembolism. The present study aimed to investigate the prevalence of systemic and venous thromboembolism as well as major bleeding and mortality in relation to underlying risk factors and the impact of anticoagulation use in hospitalized patients with COVID-19.Methods and results: Patients with COVID-19 admitted to Union Hospital, Wuhan, Hubei, China between January 08, 2020 and April 7, 2020 were enrolled in this retrospective study. Cox proportional hazard models were utilized to determine associated risk factors for clinical events, adjusting for the severity of COVID-19 infection, drug therapies, comorbidities, surgery, and use of antithrombotic drugs.There were 1125 patients (49.9% male; mean age 58 years (standard deviation, SD, 15 years)) with a mean follow-up of 21 (SD 13) days. Approximately 25 (30%) patients with thromboembolism also suffered bleeding events.Age was an independent risk factor for thromboembolism, bleeding events, and death (all p<0.05). After adjusting for the severity of COVID-19 infection, comorbidities, surgery, antiviral drugs, immunomodulators, Chinese herbs, and antithrombotic drugs, low lymphocyte counts (hazard ratio, HR, 95% confidence interval (CI), 1.03, 1.01-1.05, p=0.01) and surgery (HR 2.80, 1.08-7.29, p=0.03) independently predicted the risk for major bleeding, whereas liver dysfunction (HR 4.13, 1.30-13.1, p=0.02) was an independent risk factor for patients with both thromboembolism and bleeding events.Conclusions: Patients with COVID-19 were at high risk for thromboembolic and bleeding events as well as mortality. The use of anticoagulants, especially parenteral anticoagulants, significantly reduced the risk for composite outcomes of thromboembolism, bleeding events, and death. The presence of AF was a contributor to systemic thromboembolism in COVID-19 patients.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic has resulted in approximately 3 million infections globally, with over 200,000 deaths, mainly due to severe acute respiratory syndrome and multiorgan dysfunction [1]
The present study aimed to investigate the prevalence of systemic and venous thromboembolism as well as major bleeding and mortality in relation to underlying risk factors and the impact of anticoagulation use in hospitalized patients with COVID-19
Patients with COVID-19 were at high risk for thromboembolic and bleeding events as well as mortality
Summary
The coronavirus disease 2019 (COVID-19) pandemic has resulted in approximately 3 million infections globally, with over 200,000 deaths, mainly due to severe acute respiratory syndrome and multiorgan dysfunction [1]. Increased mortality and morbidity from thromboembolism, especially venous thromboembolism, have been reported, commonly in critically ill COVID-19 patients [7,8,9]. These acute thromboembolic events were strongly associated with worsening outcomes, highlighting the necessity for thromboembolism risk management [10]. Despite the data on venous thromboembolism in COVID-19, there are more limited data on systemic thromboembolism and the value of anticoagulation regimens in balancing the risks of major bleeding. One study showed that anticoagulants reduced mortality in COVID-19 patients with D-dimer > 3.0 μg/mL [11], but there appear to be empiric therapeutic anticoagulation approaches in current practice. Intermediate-dosage low-molecularweight heparin (LMWH) thromboprophylaxis (40-60 mg) is commonly used in Chinese patients [11], whereas higher dosages (i.e., 80-100 mg) are considered in Italy [12]
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