Deep Venous Thrombosis in Hospitalized Patients with Coronavirus Disease 2019

Objectives The pandemic of Coronavirus disease 2019 (COVID-19) has caused devastating morbidity and mortality worldwide In particular, thromboembolic complications have emerged as a key threat in COVID-19 We assessed our experience with deep venous thrombosis (DVT) in patients with COVID-19 Methods We performed a retrospective analysis of all patients with COVID-19 undergoing upper or lower extremity venous duplex ultrasonography at an academic health system in New York City between March 3 2020 and April 12 2020 with follow-up through May 12 2020 A cohort of hospitalized patients without COVID-19 (non-COVID-19) undergoing venous duplex ultrasonography from December 1 2019 to December 31 2019 was used for comparison The primary outcome was DVT Secondary outcomes included pulmonary embolism (PE), in-hospital mortality, admission to intensive care unit, and antithrombotic therapy Multivariable logistic regression was performed to identify risk factors for DVT and mortality Results Of 443 patients (188 COVID-19 and 255 non-COVID-19) undergoing venous duplex ultrasonography, patients with COVID-19 had higher incidence of DVT (31% vs 19%;P=0 005), compared to the non-COVID-19 cohort The incidence of PE was not statistically different between the COVID-19 and non-COVID-19 cohorts (8% vs 4%;P= 105) The DVTs in the COVID-19 group were more distal (63% vs 29%;P< 001) and bilateral (15% vs 4%;P< 001) The result of duplex ultrasonography had a significant impact on the antithrombotic plan;42 (72%) patients with COVID-19 in the DVT group had their therapies escalated while 49 (38%) and 3 (2%) patients had their therapies escalated and de-escalated in the non-DVT group, respectively (P< 001) Within the COVID-19 cohort, the D-dimer was significantly higher in the DVT group at the time of admission (2,746 ng/mL vs 1,481 ng/mL;P= 004) and at the time of the duplex exam (6,068 ng/mL vs 3,049 ng/mL;P<0 01) At multivariable analysis, male sex (odd ratio (OR) 2 27;95% confidence interval (CI), 1 06-4 87;P= 035), ICU admission (OR 3 42;95% CI, 1 02-11 44;P= 046) and extracorporeal membrane oxygenation (OR 5 5;95% CI, 1 01-30 13;P= 049) were independently associated with DVT Conclusion Given the high incidence of venous thromboembolic events in this population, we support the decision to empirically initiate therapeutic anticoagulation in patients with low bleeding risk and severe COVID-19 infection, with duplex ultrasonography reserved for patients with high clinical suspicion of VTE in which anticoagulation may pose a life-threatening consequence Further study is warranted in patients with COVID-19 to elucidate the etiology of vascular thromboembolic events and guide prophylactic and therapeutic interventions in these patients