ABSTRACT
Background: The aim of the study was to analyze the results of treatment and the factors of risk of mortality among the patients with COVID-19 and venous thromboembolism (VTE). Method(s): Retrospective analysis of 87 patients with COVID-19 and VTE treated fromApril 2020 to March 2021 in the City HospitalNo40 of Yekaterinburg was performed. Demographic, clinical and laboratory data, including duplex ultrasound, multispiral CT pulmonary angiograms, Charlson index were retrieved. Comparisons were made between two groups: Survivors (n=39) and deceased (n=48). Statistical processing was performed using EZR v. 4.1.2. Result(s): Among 87 patients hospitalized with COVID- 19 (average age - 68 years, 48(55,2%) women) intensive care was required for 61(70,1%) patients. Duplex ultrasound showed 74 deep vein thrombosis (DVT);53(71,6%) - distal DVT, 13(17,6%) - femoropopliteal DVT, 1(1,3%) - iliofemoral DVT, 3(4,1%) - surface veins of extremities, 3(4,1%) - inferior vena cava, 1(1,3%) - right heart chambers. Bilateral lower extremity DVT developed in 29(39,7%) patients. Isolated venous thrombosis was observed in 47(54,1%) patients. 27(31,0%) patients with venous thrombosis had pulmonary embolism (PE), in 13(14,9%) patients with PE the source was not found. In 17(23%) cases DVT had free flotation. Before the identification of VTE, all patients were receiving direct anticoagulants: Prophylactic doses - 31(35,6%), intermediate doses - 33(37,9%), therapeutic doses - 23(26,4%). Deceased patients were older than survivors (average age - 71,0 years (IQR 61,0;81,2);r=0,012). Severe COVID-19, requirement of intensive therapy and mechanical lung ventilation prevailed in the group of deceased (p<0,001). Charlson index was higher in the group of deceased (6,0 (IQR 4,0;6,2) vs 4,0 (IQR 2,0;5,0);p=0,007). The index of 5 points and more showed that the probability of death increased by 3 times (OR 2,98, 95% SI 1,2-7,1;p=0,01). In the structure of VTE in the group of deceased, DVT was mainly in combination with PE of 20(47,1%);p=0,027. In both groups, distal DVT was more frequent: 21(61,8%) among the survivors, 32(80,0%) among the deceased. The localization of venous thrombosis, flotation, bilateral DVT of the lower extremities were not statistically different in the studied groups. Laboratory indicators: D-dimer (3955.0 ng/ml (IQR 2550,0;5325,0) - survivors, 4600,0 ng/ml (IQR 2745,0;38300,0) - deceased;p=0,291);hyperfibrinogenemy (5,2 g/l (IQR 4,0;6,5) - deceased;r=0,033). The dose of direct anticoagulants before the identification VTE was not statistically significant. Conclusion(s): The factors of unfavorable outcome in patients of COVID-19 and VTE were: Age, Charlson index higher than 4 points, intensive therapy, mechanical lung ventilation, DVT in combination with PE. The dose of direct anticoagulants before to the detection of VTE did not affect the unfavorable outcome in the studied category of patients.