Feature
The COVID–clot connection
A review of thrombotic complications with COVID-19 By Karlyn Martin, MD, and Kush Desai, MD, FSIR
a retrospective multi-center study of patients hospitalized in the United States through April 2020 demonstrated a VTE rate of 4.8% (95% confidence interval [CI], 2.9–7.3) and a thrombotic complication rate of 9.5% (95% CI, 6.8–12.8%).2
T
hrombotic complications, including venous thromboembolism (VTE), myocardial infarction and
central catheter or device occlusion, are recognized causes of morbidity and mortality in patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection. Though data collected during this period were extremely variable due to heterogeneity of study methods, including screening methods, ability
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to obtain confirmatory images and inconsistent use of thromboprophylaxis, studies from the early phases of the COVID-19 pandemic supported that there was an increased rate of thrombosis in patients with COVID-19 illness.
Early data For example, initial data from the first three months of the recognized outbreak in Wuhan, China, demonstrated a 25% incidence of VTE in patients with COVID-19,1
whereas
As the pandemic continued, there remained an increased risk of thrombosis in all patients admitted with COVID-19, and it became clear that a large part of this clinical incidence was due to a particularly high rate of VTE in patients with critical illness. Data from Netherlands showed a thrombotic incidence of 49% (95% CI, 41–57%) despite thromboprophylaxis, of which 87% were pulmonary embolism.3 Further, a meta-analysis of 86 studies and over 28,000 patients through August 2020 found VTE rates of 22.7% (95% CI, 18.1–27.6) in patients in the intensive care unit (ICU); patients that were not admitted to the ICU had a VTE rate of 7.9% (95% CI, 5.1-11.2).4 Additionally, historical VTE rates in patients that did not have COVID-19 that were admitted to the ICU was 5–15%.4
Reported VTE rates remained
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