Abstract Number: PB0174
Meeting: ISTH 2021 Congress
Theme: COVID and Coagulation » COVID and Coagulation, Clinical
Background: COVID-19 patients appear to be at increased risk for venous thromboembolism (VTE), however data on arterial thromboembolism (ATE) is still limited.
Aims: We report a case series of thromboembolic events (TE) in COVID-19 patients admitted to a Portuguese hospital.
Methods: In 290 patients with confirmed COVID-19 admitted between October and December 2020, clinical records were searched for TE. Admission levels of fibrinogen, D-dimers, C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH) and complete blood counts were evaluated. Statistical analysis was conducted using IBM SPSS®.
Results: Of the 290 patients (M/F 179/111; median age 70-years-old (interquartile range: 58-78); 79 in Intensive Care Units (ICU)), 8.6% had TE (n=25). Of these, 64%(n=16) had ATE (44% ischaemic strokes and 20% ST-elevation myocardial infarctions); 28%(n=7) had VTE (16% pulmonary embolisms and 12% other) and 8% had multiple events. The overall incidence of ATE was 6,2% and VTE 3,1%.
Most TE (n=17, 68%), of which 76% ATE, were detected upon admission to hospital, despite prior antiplatelet therapy in six patients (35.3%). Among TE in hospitalized patients, 87.5% occurred despite anticoagulant therapy.
Admissions to ICU and mortality were higher in patients with TE than in patients without thrombosis (non-TE) (44% vs 27.2%; p=0.003 and 28% vs 20.76%; p=0.402, respectively). Patients with TE presented significantly lower levels of fibrinogen and CRP and higher D-dimers, when compared with matched non-TE patients (Table 1). Further statistically significant differences were found were found between ATE and VTE groups, as presented in Table 1.
| Admission Levels | Non-TE (n=24) |
TE (n=25) |
ATE (n=16) |
VTE (n=7) |
TE/non-TE | ATE/non-TE | VTE/non-TE | ATE/VTE |
| Fibrinogen (g/L) | 6.20 (4.56-7.22) |
4.63 (3.51-5.00) |
4.41 (3.32-4.94) |
4.35 (3.73-7.30) |
p=0.014 | p=0.010 | n.s. | n.s. |
| CRP (mg/L) | 126.4 (100.6-181) |
77.0 (13.5-169.5) |
41.6 (7.8-136.7) |
78.4 (41.2-215) |
p=0.021 | p=0.007 | n.s. | n.s. |
| D-dimer (ng/mL) | 753.5 (363-1112) |
1128 (451-5250) |
666 (420-1428) |
2645 (872-5250) |
p=0.049 | n.s. | p=0.014 | n.s. |
| LDH (U/L) |
361 (270-492) |
357 (204-554) |
237 (189-371) |
478 (392-561) |
n.s. | p=0.037 | n.s. | p=0.018 |
| Ferritin (ng/mL) | 1555 (887-2158) |
1220 (325-1978) |
730 (300-1483) |
1707 (808-2318) |
n.s. | p=0.045 | n.s. | n.s. |
| Monocytes (103/μL) | 0.44 (0.30-0.70) |
0.64 (0.36-0.88) |
0.67 (0.52-0.89) |
0.35 (0.32-0.78) |
n.s. | p=0.033 | n.s. | n.s. |
Median values of relevant laboratorial parameters upon admission and comparison between groups. Interquartile range shown in brackets. Statistical significance calculated using a Kruskal-Wallis test. Non-TE patients were matched with TE patients by age, sex and severity of disease (defined by length of stay and highest level of care). Patients with multiple events were not included in the ATE/VTE subgroups analysis. Lack of statistical significance indicated as n.s.
Conclusions: Data from these patients point to an early occurrence of TE and an increased incidence of ATE over VTE. The significantly diminished inflammation markers, together with the early presence of TE (68% at admission) in patients otherwise without reason for hospitalization, may suggest, at least for ATE events, a direct role of SARS-CoV-2 in thrombotic process.
To cite this abstract in AMA style:
de Oliveira M, Cubal F, Oliveira J, Cruz E, Coutinho M, Pereira M, Matos R, Pinho N, Moreira L, Seidi N, Morais S. High Incidence and Early Presence of arterial thrombotic events in a COVID-19 hospitalized population: an overlooked problem? [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/high-incidence-and-early-presence-of-arterial-thrombotic-events-in-a-covid-19-hospitalized-population-an-overlooked-problem/. Accessed November 27, 2021.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/high-incidence-and-early-presence-of-arterial-thrombotic-events-in-a-covid-19-hospitalized-population-an-overlooked-problem/