DOI: http://dx.doi.org/10.18203/2349-3933.ijam20221007

Study of thrombotic complications in COVID-19

Raghavendra B. M., Imran Khan

Abstract


Background: In December of 2019, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) began to infect humans in the city of Wuhan and has rapidly become pandemic. Recent clinical trials suggested that COVID-19 related thromboembolic complications are the major cause for increased incidence of morbidity and mortality. We conducted a prospective observational study to evaluate the prevalence of vascular complications due to COVID-19 and to analyse the difference in the inflammatory markers before and after the events.

Methods: Prospective observational study, conducted at department of general medicine, Bangalore Medical College, Bangalore Karnataka from 3 months, 01 August 2021 to 30 October 2020. The incidence of thrombotic events was 70.7% (53/75). The incidence of arterial thromboembolic events was 48%, involving 36 patients of the overall study population. Of these 36 patients, majority of them were suffering from cerebrovascular accident (CVA) accounting for about 12 (16%) of the patients followed by 11 (14.7%) with ischemic heart disease (IHD). About 22.66% (17/75) of patients had developed venous thromboembolic events. Of which, 13 (17.3%) patients had developed deep-vein thrombosis (DVT).

Results: We observed that all the inflammatory markers had significantly increased after the onset of thrombotic events. Serum ferritin, lactate dehydrogenase (LDH), interleukin-6 (IL-6) and fibrinogen were almost raised by 50% of the pre-event values. We could not calculate the sensitivity, specificity, positive predictive value and negative predictive value for each parameter as the severity of the disease was widely distributed. Majority of these thrombotic events were observed among the patients aged >60 years and those with comorbid conditions. But there no statistically significant difference observed.

Conclusions: We concluded that COVID-19 causes significantly increased surge of inflammatory markers and thereby the significantly increased prevalence of arterial and venous thrombotic events.


Keywords


Thrombotic events, COVID-19, Arterial thromboembolic events, Venous thromboembolic events

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References


Avila J, Long B, Holladay D, Gottlieb M. Thrombotic complications of COVID-19. Am J Emerg Med. 2021;39:213-8.

India: WHO coronavirus (COVID 19) dashboard. Available at: https://covid19.who.int/region/searo/country/in. Accessed on 12 July 2021.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.

Panigada M, Bottino N, Tagliabue P. Hypercoagulability of COVID-19 patients in intensive care unit: a report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost. 2020;18(7):1738-42.

Ni W, Yang X, Yang D, Bao J, Li R, Xiao Y, et al. Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19. Crit Care. 2020;24(1):422.

Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020;18(6):1421-4.

Klok FA, Kruip MJHA, van der Meer NJM. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145-7.

Jenner WJ, Gorog DA. Incidence of thrombotic complications in COVID-19 : On behalf of ICODE: The International COVID-19 Thrombosis Biomarkers Colloquium. J Thromb Thrombolysis. 2021;52(4):999-1006.

Middeldorp S, Coppens M, van Haaps TF, Foppen M, Vlaar AP, Müller MCA, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 2020;18(8):1995-2002.

Piazza G, Campia U, Hurwitz S. Registry of arterial and venous thromboembolic complications in patients with COVID-19. J Am Coll Cardiol. 2020;76:2060-72.

Rey JR, Caro-Codón J, Poveda Pineda D, Merino JL, Iniesta ÁM, López-Sendón JL; CARD-COVID investigators. Arterial thrombotic complications in hospitalized patients with COVID-19. Rev Esp Cardiol (Engl Ed). 2020;73(9):769-771.

Fournier M, Faille D, Dossier A, Mageau A, Nicaise Roland P, Ajzenberg N, et al. Arterial Thrombotic Events in Adult Inpatients With COVID-19. Mayo Clin Proc. 2021;96(2):295-303.

Hill JB, Garcia D, Crowther M, Savage B, Peress S, Chang K, Deitelzweig S. Frequency of venous thromboembolism in 6513 patients with COVID-19: a retrospective study. Blood Adv. 2020;4(21):5373-7.

Bilaloglu S, Aphinyanaphongs Y, Jones S, Iturrate E, Hochman J, Berger JS. Thrombosis in Hospitalized Patients With COVID-19 in a New York City Health System. JAMA. 2020;324(8):799-801.

Jenner WJ, Kanji R, Mirsadraee S, Gue YX, Price S, Prasad S, Gorog DA. Thrombotic complications in 2928 patients with COVID-19 treated in intensive care: a systematic review. J Thromb Thrombolysis. 2021;51(3):595-607.

Hanif A, Khan S, Mantri N, Hanif S, Saleh M, Alla Y, Chinta S, Shrestha N, Ji W, Attwood K, Adrish M, Jain KR. Thrombotic complications and anticoagulation in COVID-19 pneumonia: a New York City hospital experience. Ann Hematol. 2020;99(10):2323-8.

Alonso-Fernández A, Toledo-Pons N, Cosío BG, Millán A, Calvo N, Ramón L, et al. Prevalence of pulmonary embolism in patients with COVID-19 pneumonia and high D-dimer values: A prospective study. PLoS One. 2020;15(8):e0238216.

Al-Samkari H, Karp Leaf RS, Dzik WH, Carlson JCT, Fogerty AE, Waheed A, et al. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood. 2020;136(4):489-500.