Venous Thromboembolism in Patients Hospitalized with COVID-19: Results from the Brazilian COVID-19 Registry

W.C. Silveira¹, S.M. Rezende¹, M.A.P. Martins¹, M.C. Pires¹, R.T. Silva¹, L.E.F. Ramos¹, M.V.R.S. Silva¹, T.L.S. Sales², C.C.R. Cimini³, M.H. Guimarães Júnior⁴, F.G. Aranha⁵, M.C.A. Nogueira⁶, L.B. Moreira⁷, T.O. Fereguetti⁸, P.L. Assaf⁹, M. Carneiro¹⁰, M.S. Marcolino¹, S.F. Araújo¹¹, A.V. Schwarbold¹², G.A.N. Bastos¹³

¹Federal University of Minas Gerais, Belo Horizonte, Brazil, ²Federal University of São João del-Rei, Divinópolis, Brazil, ³Hospital Santa Rosália, Teófilo Otoni, Brazil, ⁴Hospital Márcio Cunha, Ipatinga, Brazil, ⁵Hospital SOS Cárdio, Florianópolis, Brazil, ⁶Hospital Rede Mater Dei, Belo Horizonte, Brazil, ⁷Hospital das Clínicas de Porto Alegre, Porto Alegre, Brazil, ⁸Hospital Eduardo de Menezes, Belo Horizonte, Brazil, ⁹Hospital Metropolitano Doutor Célio de Castro, Belo Horizonte, Brazil, ¹⁰Hospital Santa Cruz, Santa Cruz do Sul, Brazil, ¹¹Hospital Semper, Belo Horizonte, Brazil, ¹²Hospital Universitário de Santa Maria, Santa Maria, Brazil, ¹³Hospital Moinhos de Vento, Porto Alegre, Brazil

Abstract Number: PB1192

Meeting: ISTH 2021 Congress

Theme: Venous Thromboembolism » VTE Epidemiology

Background: COVID-19 patients are at increased risk of venous thromboembolism (VTE), and this complication leads to a worse prognosis. However, to diagnose VTE on COVID-19 patients is a challenge to physicians, as the symptoms of pulmonary embolism can often be mistaken for the overlapped viral pneumonia. Herein, there is still little information on VTE incidence and associated risk factors specifically for this population.

Aims: To assess the incidence and associated risk factors for VTE in hospitalized COVID-19 patients in Brazilian hospitals.

Methods: Retrospective multicenter cohort in 15 Brazilian hospitals. Consecutive adult patients (≥ 18 years-old) with laboratory-confirmed COVID-19 between March and September 2020 were included. Study data were collected from medical records using Research Electronic Data Capture (REDCap) tools. The study was approved by the National Research Ethics Commission waiving off the application of informed consent.

Results: Of 4,021 patients included, 234 (5.8%) had VTE. When comparing VTE and non-VTE groups (Tables 1 and 2), there was no statistical difference in terms of sex and age between groups. The median age was 63 years-old (IQR 51-72 years-old) in VTE group. The most common comorbidities for both groups were hypertension and diabetes. Obesity, chronic pulmonary obstructive disease, previous VTE and recent surgery were more frequent in VTE group. D-dimer, C-reactive protein, lactate dehydrogenase levels and lymphocyte count were higher in the VTE group. Admission to intensive care units (37.6% vs 69.7%; p < 0,001) and in-hospital mortality (19.0% vs 28.3%; p< 0,01) were significantly higher in those who had VTE.

Characteristic	Total Number	no-VTE (n= 3,787)	VTE (n = 234)	p-value
Age (years)	4,021	61.0 (48.0, 72.0)	63.0 (51.0, 72.0)	0.161
Male sex at birth	4,020	2,098 (55.4%)	126 (53.8%)	0.689
Comorbidities
Hypertension	4,021	2,059 (54.4%)	129 (55.1%)	0.874
COPD	4,021	228 (6.0%)	24 (10.3%)	0.014
Diabetes mellitus	4,021	1,068 (28.2%)	74 (31.6%)	0.293
Obesity (BMI ³ 30kg/m²)	4,021	683 (18.0%)	55 (23.5%)	0.044
Previous VTE	4,021	25 (0.7%)	5 (2.1%)	0.028
Surgery up to 90 days	4,015	89 (2.4%)	12 (5.1%)	0.016

Main demographic features of the COVID-19 hospitalized patients cohort

Characteristic	Total No	no-VTE (n= 3,787)	VTE (n = 234)	p-value
Laboratory parameters
D-dimer	3,275	2.0 (1.1, 7.8)	4.1 (1.5, 27.5)	<0.001
C reactive protein (mg/L)	3,602	73.0 (33.7, 131.0)	92.3 (55.0, 172.1)	<0.001
Lactate dehydrogenase	2,565	376.0 (273.0, 514.0)	407.0 (328.0, 603.0)	<0.001
Leukocytes count	3,940	6.9 (5.1, 9.5)	8.7 (5.9, 12.4)	<0.001
Outcomes
In hospital mortality	4,013	719 (19.0%)	66 (28.3%)	<0.001
Intensive care unit	4,017	1,424 (37.6%)	163 (69.7%)	<0.001

Main clinical characteristics, laboratory-values and outcomes of the COVID-19 hospitalized patients cohort

Conclusions: Overall, 5.8% of COVID-19 hospitalized patients had VTE. Elevated laboratory values were associated with increased risk of this condition. VTE was associated with higher rates of intensive care admission and in-hospital mortality.

To cite this abstract in AMA style:

Silveira WC, Rezende SM, Martins MAP, Pires MC, Silva RT, Ramos LEF, Silva MVRS, Sales TLS, Cimini CCR, Guimarães Júnior MH, Aranha FG, Nogueira MCA, Moreira LB, Fereguetti TO, Assaf PL, Carneiro M, Marcolino MS, Araújo SF, Schwarbold AV, Bastos GAN. Venous Thromboembolism in Patients Hospitalized with COVID-19: Results from the Brazilian COVID-19 Registry [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/venous-thromboembolism-in-patients-hospitalized-with-covid-19-results-from-the-brazilian-covid-19-registry/. Accessed December 5, 2021.

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