Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy
Open accessAbstract
Background Few data are available on the rate and characteristics of thromboembolic complications in hospitalized patients with COVID-19.Methods We studied consecutive symptomatic patients with laboratory-proven COVID-19 admitted to a university hospital in Milan, Italy (13.02.2020-10.04.2020). The primary outcome was any thromboembolic complication, including venous thromboembolism (VTE), ischemic stroke, and acute coronary syndrome (ACS)/myocardial infarction (MI). Secondary outcome was overt disseminated intravascular coagulation (DIC).Results We included 388 patients (median age 66 years, 68% men, 16% requiring intensive care [ICU]). Thromboprophylaxis was used in 100% of ICU patients and 75% of those on the general ward. Thromboembolic events occurred in 28 (7.7% of closed cases; 95%CI 5.4%-11.0%), corresponding to a cumulative rate of 21% (27.6% ICU, 6.6% general ward). Half of the thromboembolic events were diagnosed within 24 h of hospital admission. Forty-four patients underwent VTE imaging tests and VTE was confirmed in 16 (36%). Computed tomography pulmonary angiography (CTPA) was performed in 30 patients, corresponding to 7.7% of total, and pulmonary embolism was confirmed in 10 (33% of CTPA). The rate of ischemic stroke and ACS/MI was 2.5% and 1.1%, respectively. Overt DIC was present in 8 (2.2%) patients.Conclusions The high number of arterial and, in particular, venous thromboembolic events diagnosed within 24 h of admission and the high rate of positive VTE imaging tests among the few COVID-19 patients tested suggest that there is an urgent need to improve specific VTE diagnostic strategies and investigate the efficacy and safety of thromboprophylaxis in ambulatory COVID-19 patients.
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AMI has been described in patients with COVID-19, probably related to large vessel thromboembolic events as well as to small vessel thrombosis linked to hypercoagulability and fibrinolysis shutdown.
“AMI has been described in patients with coronavirus disease (COVID -19), probably related to large vessel thromboembolic events as well as to small vessel thrombosis linked to hypercoagulability and fibrinolysis shutdown [36].”
From Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. (2022) · cites this paper as [36]
The Results report thromboembolic events in patients with COVID-19, including acute coronary syndrome/myocardial infarction, and the Discussion describes coagulation activation. The paper does not report acute mesenteric ischemia, if that is what AMI denotes here, or link it to large- or small-vessel thrombosis or fibrinolysis shutdown. No page numbers are available in our copy. (LLM, conf=0.82)
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- Authors
- Lodigiani, C., Iapichino, G., Carenzo, L., Cecconi, M., Ferrazzi, P., Sebastian, T., Kucher, N., Studt, J.-D., Sacco, C., Bertuzzi, A., Sandri, M. T., & Barco, S.
- Affiliations
- Humanitas University (IT)
- IRCCS Humanitas Research Hospital (IT)
- University Hospital Zurich (CH)
- Johannes Gutenberg University Mainz (DE)
- Corresponding author
- Lodigiani, Corrado
- ORCID
- Venue
- Thrombosis Research
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 191
- Pages
- 9-14
- ISSN
- 0049-3848 (ISSN-L)
- PMC
- PMC7177070
- OpenAlex
- W3019953082
- Cited by
- 2,054
- References
- 20
- Citations by year
- 2026: 17 · 2025: 44 · 2024: 94 · 2023: 186 · 2022: 389 · 2021: 632 · 2020: 689 · 2012: 1
- FWCI
- 62.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thrombosis Research (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Bundesministerium für Bildung und Forschung (01EO1503, 01EO1003)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- COVID-19 pandemic, venous thromboembolism, arterial thromboembolism, pulmonary embolism, ischemic stroke, acute coronary syndrome, myocardial infarction, disseminated intravascular coagulation, thromboprophylaxis, hospitalized patients
- MeSH terms
- COVID-19, Aged, Aged, 80 and over, Ambulatory Care, Anticoagulants, Arterial Occlusive Diseases, Brain Ischemia, Coronary Thrombosis, Critical Care, Disseminated Intravascular Coagulation, Female, Hospitals, Teaching, Hospitals, Urban, Humans, Italy, Length of Stay, Male, Middle Aged, Patient Admission, Pneumonia, Viral, Pulmonary Embolism, Retrospective Studies, Risk Factors, Comorbidity, Hospital Mortality, Coronavirus Infections, Thrombophilia, Acute Coronary Syndrome, Venous Thromboembolism, Pandemics
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