https://doi.org/10.4081/monaldi.2023.2617
Venous thromboembolism and major bleeding in severe and critical COVID-19 hospitalized patients
Submitted: April 24, 2023
Accepted: June 7, 2023
Published: July 5, 2023
Accepted: June 7, 2023
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Venous thromboembolism (VTE) and major bleeding (MB) are life-threatening complications described in COVID-19 hospitalized patients and they can be considered as two sides of the same coin. This retrospective study aims to evaluate the risk factors for VTE and MB in COVID-19 patients admitted to two Italian hospitals. The medical records of all COVID-19 patients (males 139; 62.3%, mean age 67.2±13.6 years, body weight 88.2±20.6 kg) hospitalized from March 11th to July 31st, 2020 to the Federico II University Hospital and to Sea Hospital, Naples, Italy, were analyzed. The COVID-19 patients were classified into four groups: COVID-19 patients developing VTE and/or MB, COVID-19 patients developing only VTE, COVID-19 patients developing only MB, and COVID-19 patients not developing neither VTE nor MB. During the hospitalization, 53 COVID-19 patients (24.7%; males 40; 75.5%, mean age 67.2±13.6 years, weight 88.2±20.6 kg) developed VTE, 33 COVID-19 patients (15.3 %; males 17; 51.5, mean age 67.3±14.9 years, weight 74.1±14.3 kg) developed MB, and 129 COVID-19 patients not developed neither TVP nor MB. No parameters to identify severe COVID-19 complicated by VTE and/or MB were found. However, some clinical and biochemical parameters can be evaluated to predict the risk of MB in order to modify the treatment and take prompt action to reduce mortality.
Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020;395:514-523.
DOI: https://doi.org/10.1016/S0140-6736(20)30154-9
World Health Organization. COVID-19 Dashboard. 2020. Available from: https://covid19.who.int/
Gattinoni L, Gattarello S, Steinberg I, et al. COVID-19 pneumonia: pathophysiology and management. Eur Resp Rev 2021;30:210138.
DOI: https://doi.org/10.1183/16000617.0138-2021
Marietta M, Coluccio V, Luppi M. COVID-19, coagulopathy and venous thromboembolism: more questions than answers. Intern Emerg Med 2020;151375-87.
DOI: https://doi.org/10.1007/s11739-020-02432-x
Lodigiani C, Iapichino G, Carenzo L, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res 2020; 91:9-14.
DOI: https://doi.org/10.1016/j.thromres.2020.04.024
Helms J, Tacquard C, Severac F, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intens Care 2020; 46:1089-98.
DOI: https://doi.org/10.1007/s00134-020-06062-x
Fraissé M, Logre E, Pajot O, et al. Thrombotic and hemorrhagic events in critically ill COVID-19 patients: a French monocenter retrospective study. Crit Care 2020;24:275.
DOI: https://doi.org/10.1186/s13054-020-03025-y
Henderson SR, Salama AD. Haemorrhage and thrombosis: tackling two sides of a single vasculitic disease. Nephrol Dial Transplant 2012;27:4243-4.
DOI: https://doi.org/10.1093/ndt/gfs390
Xu SW, Ilyas I, Weng JP. Endothelial dysfunction in COVID-19: an overview of evidence, biomarkers, mechanisms and potential therapies. Acta Pharmacol Sin 2023;44:695-709.
DOI: https://doi.org/10.1038/s41401-022-00998-0
Tufano A, Rendina D, Abate V, et al Venous thromboembolism in COVID-19 compared to non-COVID-19 cohorts: a systematic review with meta-analysis. J Clin Med 2020;10:4925.
DOI: https://doi.org/10.3390/jcm10214925
Shah A, Donovan K, McHugh A, et al. Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study. Crit Care 2020;24:561.
DOI: https://doi.org/10.1186/s13054-020-03260-3
Abate V, Casoria A, Rendina D, et al. Spontaneous muscle hematoma in patients with COVID-19: a systematic literature review with description of an additional case series. Semin Thromb Hemost 2021;48:100-8.
DOI: https://doi.org/10.1055/s-0041-1732370
Deitelzweig S, Luo X, Nguyen JL, et al. Thrombotic and bleeding events, mortality, and anticoagulant use among 546,656 hospitalized patients with COVID-19 in the United States: a retrospective cohort study. J Thromb Thrombolysis 2022;53:766-76.
DOI: https://doi.org/10.1007/s11239-022-02644-2
Willan J, Agarwal G, Bienz N. Mortality and burden of post-COVID-19 syndrome have reduced with time across SARS-CoV-2 variants in haematology patients. Br J Haematol 2023;201:640-4.
DOI: https://doi.org/10.1111/bjh.18700
World Health Organization. Laboratory testing for coronavirus disease (COVID-19) in suspected human cases: interim guidance, 19 March 2020. Available from: https://apps.who.int/iris/handle/10665/331501
Huisman MV, Klok FA. Diagnostic management of acute deep vein thrombosis and pulmonary embolism. J Thromb Haemost 2013;11:412-22.
DOI: https://doi.org/10.1111/jth.12124
Dronkers CE, Klok FA, Huisman MV. Current and future perspectives in imaging of venous thromboembolism. J Thromb Haemost 2016;14:1696-710.
DOI: https://doi.org/10.1111/jth.13403
Kaatz S, Ahmad D, Spyropoulos AC, et al. Definition of clinically relevant non-major bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non-surgical patients: communication from the SSC of the ISTH. J Thromb Haemost 2015;13:2119-26.
DOI: https://doi.org/10.1111/jth.13140
Tang N, Li D, Wang X, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020;18:844-7.
DOI: https://doi.org/10.1111/jth.14768
Montazersaheb S, Hosseiniyan Khatibi SM, Hejazi MS, et al. COVID-19 infection: an overview on cytokine storm and related interventions. Virol J 2022;19:92.
DOI: https://doi.org/10.1186/s12985-022-01814-1
Chen R, Lan Z, Ye J, et al. Cytokine storm: the primary determinant for the pathophysiological evolution of COVID-19 deterioration. Front Immunol 2021;12:589095.
DOI: https://doi.org/10.3389/fimmu.2021.589095
Aires RB, Soares AASM, Gomides APM, et al. Thromboelastometry demonstrates endogenous coagulation activation in nonsevere and severe COVID-19 patients and has applicability as a decision algorithm for intervention. PLoS One 2022;17:e0262600.
DOI: https://doi.org/10.1371/journal.pone.0262600
Burn E, Duarte-Salles T, Fernandez-Bertolin S, et al. Venous or arterial thrombosis and deaths among COVID-19 cases: a European network cohort study. Lancet Infect Dis 2022;22:1142-52.
DOI: https://doi.org/10.1016/S1473-3099(22)00223-7
Altschul DJ, Unda SR, de La Garza Ramos R, et al. Hemorrhagic presentations of COVID-19: Risk factors for mortality. Clin Neurol Neurosurg 2020;198:106112.
DOI: https://doi.org/10.1016/j.clineuro.2020.106112
Katsoularis I, Fonseca-Rodríguez O, Farrington P, et al. Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study. BMJ 2022;377:e069590.
DOI: https://doi.org/10.1136/bmj-2021-069590
How to Cite
Abate, Veronica, Anita Vergatti, Aniello Casoria, Aquilino Flavio Zarrella, Riccardo Muscariello, Vincenzo Nuzzo, Maria Vargas, Giuseppe Servillo, Paolo Conca, Lanfranco D’Elia, Gabriella Iannuzzo, Pietro Venetucci, Gianpaolo De Filippo, Domenico Rendina, and Antonella Tufano. 2023. “Venous Thromboembolism and Major Bleeding in Severe and Critical COVID-19 Hospitalized Patients”. Monaldi Archives for Chest Disease, July. https://doi.org/10.4081/monaldi.2023.2617.
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