tetano
Editor, Senior Moderator
Eur J Emerg Med
. 2021 Jun 1;28(3):218-226.
doi: 10.1097/MEJ.0000000000000783.
Incidence, risk factors, clinical characteristics and outcomes of deep venous thrombosis in patients with COVID-19 attending the Emergency Department: results of the UMC-19-S8
S?nia Jim?nez[SUP] 1 [/SUP], ?scar Mir?[SUP] 1 [/SUP], Pere Llorens[SUP] 2 [/SUP], Francisco J Mart?n-S?nchez[SUP] 3 [/SUP], Guillermo Burillo-Putze[SUP] 4 [/SUP], Pascual Pi?era[SUP] 5 [/SUP], Alfonso Mart?n[SUP] 6 [/SUP], Aitor Alqu?zar[SUP] 7 [/SUP], Eric J Garc?a-Lamberechts[SUP] 3 [/SUP], Javier Jacob[SUP] 8 [/SUP], Mar?a L L Grima[SUP] 9 [/SUP], Javier Mill?n[SUP] 10 [/SUP], Francisca Molina[SUP] 11 [/SUP], Patricia B Albero[SUP] 12 [/SUP], Carlos Cardozo[SUP] 1 13 [/SUP], Josep M M?dol[SUP] 14 [/SUP], Alfons Aguirre[SUP] 15 [/SUP], Ruth Gaya[SUP] 16 [/SUP], Mar?a Adroher[SUP] 17 [/SUP], Llu?s Llauger[SUP] 18 [/SUP], Juan J L D?az[SUP] 19 [/SUP], Nayra C Gonz?lez[SUP] 20 [/SUP], Paula L Arag?es[SUP] 5 [/SUP], Ana P G?mez[SUP] 21 [/SUP], Juan G Del Castillo[SUP] 3 [/SUP], Spanish Investigators on Emergency Situations TeAm (SIESTA) network
Affiliations
Abstract
Background and importance: A higher incidence of venous thromboembolism [both pulmonary embolism and deep vein thrombosis (DVT)] in patients with coronavirus disease 2019 (COVID-19) has been described. But little is known about the true frequency of DVT in patients who attend emergency department (ED) and are diagnosed with COVID-19.
Objective: We investigated the incidence, risk factors, clinical characteristics and outcomes of DVT in patients with COVID-19 attending the ED before hospitalization.
Methods: We retrospectively reviewed all COVID patients diagnosed with DVT in 62 Spanish EDs (20% of Spanish EDs, case group) during the first 2 months of the COVID-19 outbreak. We compared DVT-COVID-19 patients with COVID-19 without DVT patients (control group). Relative frequencies of DVT were estimated in COVID and non-COVID patients visiting the ED and annual standardized incidences were estimated for both populations. Sixty-three patient characteristics and four outcomes were compared between cases and controls.
Results: We identified 112 DVT in 74 814 patients with COVID-19 attending the ED [1.50?; 95% confidence interval (CI), 1.23-1.80?]. This relative frequency was similar than that observed in non-COVID patients [2109/1 388 879; 1.52?; 95% CI, 1.45-1.69?; odds ratio (OR) = 0.98 [0.82-1.19]. Standardized incidence of DVT was higher in COVID patients (98,38 versus 42,93/100,000/year; OR, 2.20; 95% CI, 2.03-2.38). In COVID patients, the clinical characteristics associated with a higher risk of presenting DVT were older age and having a history of venous thromboembolism, recent surgery/immobilization and hypertension; chest pain and desaturation at ED arrival and some analytical disturbances were also more frequently seen, d-dimer >5000 ng/mL being the strongest. After adjustment for age and sex, hospitalization, ICU admission and prolonged hospitalization were more frequent in cases than controls, whereas mortality was similar (OR, 1.37; 95% CI, 0.77-2.45).
Conclusions: DVT was an unusual form of COVID presentation in COVID patients but was associated with a worse prognosis.
. 2021 Jun 1;28(3):218-226.
doi: 10.1097/MEJ.0000000000000783.
Incidence, risk factors, clinical characteristics and outcomes of deep venous thrombosis in patients with COVID-19 attending the Emergency Department: results of the UMC-19-S8
S?nia Jim?nez[SUP] 1 [/SUP], ?scar Mir?[SUP] 1 [/SUP], Pere Llorens[SUP] 2 [/SUP], Francisco J Mart?n-S?nchez[SUP] 3 [/SUP], Guillermo Burillo-Putze[SUP] 4 [/SUP], Pascual Pi?era[SUP] 5 [/SUP], Alfonso Mart?n[SUP] 6 [/SUP], Aitor Alqu?zar[SUP] 7 [/SUP], Eric J Garc?a-Lamberechts[SUP] 3 [/SUP], Javier Jacob[SUP] 8 [/SUP], Mar?a L L Grima[SUP] 9 [/SUP], Javier Mill?n[SUP] 10 [/SUP], Francisca Molina[SUP] 11 [/SUP], Patricia B Albero[SUP] 12 [/SUP], Carlos Cardozo[SUP] 1 13 [/SUP], Josep M M?dol[SUP] 14 [/SUP], Alfons Aguirre[SUP] 15 [/SUP], Ruth Gaya[SUP] 16 [/SUP], Mar?a Adroher[SUP] 17 [/SUP], Llu?s Llauger[SUP] 18 [/SUP], Juan J L D?az[SUP] 19 [/SUP], Nayra C Gonz?lez[SUP] 20 [/SUP], Paula L Arag?es[SUP] 5 [/SUP], Ana P G?mez[SUP] 21 [/SUP], Juan G Del Castillo[SUP] 3 [/SUP], Spanish Investigators on Emergency Situations TeAm (SIESTA) network
Affiliations
- PMID: 33904528
- DOI: 10.1097/MEJ.0000000000000783
Abstract
Background and importance: A higher incidence of venous thromboembolism [both pulmonary embolism and deep vein thrombosis (DVT)] in patients with coronavirus disease 2019 (COVID-19) has been described. But little is known about the true frequency of DVT in patients who attend emergency department (ED) and are diagnosed with COVID-19.
Objective: We investigated the incidence, risk factors, clinical characteristics and outcomes of DVT in patients with COVID-19 attending the ED before hospitalization.
Methods: We retrospectively reviewed all COVID patients diagnosed with DVT in 62 Spanish EDs (20% of Spanish EDs, case group) during the first 2 months of the COVID-19 outbreak. We compared DVT-COVID-19 patients with COVID-19 without DVT patients (control group). Relative frequencies of DVT were estimated in COVID and non-COVID patients visiting the ED and annual standardized incidences were estimated for both populations. Sixty-three patient characteristics and four outcomes were compared between cases and controls.
Results: We identified 112 DVT in 74 814 patients with COVID-19 attending the ED [1.50?; 95% confidence interval (CI), 1.23-1.80?]. This relative frequency was similar than that observed in non-COVID patients [2109/1 388 879; 1.52?; 95% CI, 1.45-1.69?; odds ratio (OR) = 0.98 [0.82-1.19]. Standardized incidence of DVT was higher in COVID patients (98,38 versus 42,93/100,000/year; OR, 2.20; 95% CI, 2.03-2.38). In COVID patients, the clinical characteristics associated with a higher risk of presenting DVT were older age and having a history of venous thromboembolism, recent surgery/immobilization and hypertension; chest pain and desaturation at ED arrival and some analytical disturbances were also more frequently seen, d-dimer >5000 ng/mL being the strongest. After adjustment for age and sex, hospitalization, ICU admission and prolonged hospitalization were more frequent in cases than controls, whereas mortality was similar (OR, 1.37; 95% CI, 0.77-2.45).
Conclusions: DVT was an unusual form of COVID presentation in COVID patients but was associated with a worse prognosis.