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Arterial and venous thrombosis in coronavirus 2019 disease (Covid-19): relationship with mortality

2021; Springer Science+Business Media; Volume: 16; Issue: 5 Linguagem: Inglês

10.1007/s11739-020-02621-8

1970-9366

Francesco Violi, Giancarlo Ceccarelli, Roberto Cangemi, Francesco Cipollone, Damiano D’Ardes, Alessandra Oliva, Matteo Pirro, Monica Rocco, Francesco Alessandri, Gabriella d’Ettorre, Miriam Lichtner, Pasquale Pignatelli, Domenico Ferro, Franco Ruberto, Gregory Y.H. Lip, Francesco Pugliese, Claudio Maria Mastroianni, Francesco Pugliese, Francesco Alessandri, Franco Ruberto, Alida Albante, Daniela Auricchio, Francesco De Lazzaro, Daniela M. De Lauri, Carmela Di Santo, S. Ianni, Eugenia Magnanimi, Fabiola Ratini, Anna Sabani, Luca Titi, Paola Vaccaro, Giovanni Giordano, Chiara Manganelli, Massimo Mancone, Katia Bruno, Paola Celli, Stella Consolo, Claudia Croce, Lorena Giannetti, S. Martelli, Teresa Messina, Elisa Pattelli, Serena Perrella, Monica Portieri, Claudia Ricci, Nicole Almenräder, Roberto Arzilla, Emilia D’Elia, Claudio Di Giovanni, Amalia Laderchi, Carlotta Macrì, Maurizio Marandola, Giada Nardecchia, Massimo Pacilli, Francesca Pacini, Fabio Araimo Morselli, Carmela Imperiale, Paolo Tordiglione, Claudio Maria Mastroianni, Maria Rosa Ciardi, Camilla Ajassa, Gabriella d’Ettorre, Miriam Lichtner, Claudia D’Agostino, Gianluca Russo, Vito Trinchieri, Paola Guariglia, Laura Antonelli, Alessandra Oliva, Rosaria Maria Cuomo, Martina Carnevalini, Cristina Mastropietro, Giancarlo Iaiani, Ivano Mezzaroma, Mario Falciano, Giancarlo Ceccarelli, A Brogi, Luigi Celani, Eugenio Nelson Cavallari, Marco Rivano Capparuccia, Anna Paola Massetti, Caterina Fimiani, Marta Santori, Alessandro Bianchi, Cristiana Franchi, Maurizio De Angelis, Silvia Sereno, Caterina Furlan, Giuseppe De Sanctis, Francesca Paoletti, Patrizia Pasculli, Francesco Cogliati Dezza, Paolo Vassalini, Francesca Cancelli, Gabriella De Girolamo, Giulia Savelloni, Serena Valeri, Guido Siccardi, Federica Alessi, Gregorio Egidio Recchia, Marco Ridolfi, Francesco Eugenio Romani, Raissa Aronica, Valeria Filippi, Vera Mauro, Lorenzo Volpicelli, Matteo Candy, Alban Rugova, Silvia Di Bari, Francesca Gavaruzzi, Elena Casali, Maria Serena Carli, Antonella Maria Zingaropoli, Valentina Perri, Massimiliano De Angelis, Letizia Santinelli, Claudia Pinacchio, Parni Nijhawan, Claudia Miele, Pietro Giuseppe Innocenti, Fabio Mengoni,

COVID-19 and healthcare impacts

Abstract Background Patients with coronavirus disease 2019 (Covid-19) may experience venous thrombosis while data regarding arterial thrombosis are sparse. Methods Prospective multicenter study in 5 hospitals including 373 patients with Covid-19-related pneumonia. Demographic data, laboratory findings including coagulation tests and comorbidities were reported. During the follow-up any arterial or venous thrombotic events and death were registered. Results Among 373 patients, 75 (20%) had a thrombotic event and 75 (20%) died. Thrombotic events included 41 venous thromboembolism and 34 arterial thrombosis. Age, cardiovascular disease, intensive care unit treatment, white blood cells, D-dimer, albumin and troponin blood levels were associated with thrombotic events. In a multivariable regression logistic model, intensive care unit treatment (Odds Ratio [OR]: 6.0; 95% Confidence Interval [CI] 2.8–12.6; p < 0.001); coronary artery disease (OR: 2.4; 95% CI 1.4–5.0; p = 0.022); and albumin levels (OR: 0.49; 95% CI 0.28–0.87; p = 0.014) were associated with ischemic events. Age, sex, chronic obstructive pulmonary disease, diabetes, heart failure, coronary heart disease, intensive care unit treatment, in-hospital thrombotic events, D-dimer, C-reactive protein, troponin, and albumin levels were associated with mortality. A multivariable Cox regression analysis showed that in-hospital thrombotic events (hazard ratio [HR]: 2.72; 95% CI 1.59–4.65; p < 0.001), age (HR: 1.035; 95% CI 1.014–1.057; p = 0.001), and albumin (HR: 0.447; 95% CI 0.277–0.723; p = 0.001) predicted morality. Conclusions Covid-19 patients experience an equipollent rate of venous and arterial thrombotic events, that are associated with poor survival. Early identification and appropriate treatment of Covid-19 patients at risk of thrombosis may improve prognosis.