ABSTRACT
Coronavirus disease-19 has emerged as a devastating global public health crisis. An increased frequency of arterial and venous thrombosis was observed in COVID-19 infection. The objective of this study was to describe the thromboembolic complications of patients hospitalized for COVID-19 and their evolution. A prospective single-center study was conducted that compared the characteristics, risk factors, thromboembolic event rate, hospital stay and mortality among patients admitted to intensive care or general ward. The mean age of population was 46 ± 18 years, and 52% were female. The global rate of thromboembolic events was 4.4%, significantly higher in intensive unit patients (29% vs 1.4%;p < 0.001) despite the high use of prophylactic heparin (91.1% vs. 84.9%;p < 0.1). The independent predictive factors for the development of thromboembolic events were: age, D-dimer and creatinine. Of the patients admitted to intensive care, 45.1% required mechanical ventilation. Overall mortality was 4.3%, significantly higher in intensive care patients than in the general hospital ward (29% vs. 1.3%;p < 0.0001). Patients requiring hospitalization due to infection secondary to COVID-19 have a high rate of thromboembolic events despite the use of thromboprophylaxis with heparin, generating a negative prognostic impact on the survival of patients admitted to intensive care.
ABSTRACT
Background: Cardiovascular complications;myocardial infarction (MI), ischemic stroke, and pulmonary embolism (PE), represent an important source of adverse outcomes in COVID-19 disease. Objectives: To evaluate the incidence of thromboembolic events, specifically PE, MI and stroke;risk factors, management patterns and outcomes in patients who tested positive for COVID-19 through RT-PCR in a regional hospital. Methods: We included 1125 adults patients admitted for COVID-19 infection between April 1 and October 30, 2020. The total cohort was analyzed by site of care: Intensive care (n=124) and nonintensive care (n=1001). Results: Cardiovascular risk factors prevalence in patients with COVID- 19 were: hypertension (25.5%), hyperlipidemia (23.2%) and diabetes (12%). Prophylactic anticoagulation and therapeutic anticoagulation was prescribed in intensive care group (91.1% and 33.1%, respectively) versus (84.8% and 12.5%, respectively) in nonintensive care setting. Frequencies of major arterial or venous thromboembolism, pulmonary embolism and myocardial infarction were highest in the intensive care group (29%, 20% and 8%, respectively) than nonintensive care cohort (1.4%, 0.7% and 0,5%, respectively). Hospital mortality was 29% in intensive care group and 1.3% in nonintensive care group. Conclusions: Patients admitted for COVID-19 had a high risk of major arterial or venous thromboembolism events, especially in the intensive care setting, despite the use of thromboprophylaxis with heparin.
ABSTRACT
Coronary involve-ment in COVID-19 infection usually presents as type 2 acute myocardial infarction (AMI), due to increased 02 consumption and reduction of oxygen supply, and less frequently as type 1 (STEMI). In that cases, thrombogenicity of the infection may contribute to acute coronary occlusion. We present 2 cases of middle-aged men, with few or none cardiovascular risk factors, who were in hospital during 10 days because pneumonia due to COVID-19 with good evolution. In the convalescent phase, one day after hospital discharge, and enoxaparin suspension, they went back to hospital because STEMI. Both were treated by direct angioplasty using phar-macologic stent. Discussion is related to treatment of AMI at discharge, if anticoagulation should be added to double antiplatelet therapy, and if any prophylactic antithrombotic treatment should be considered at discharge from COVID-19 pneumonia in some patients.