Thromb Haemost 2021; 121(08): 1043-1053
DOI: 10.1055/a-1366-9656
Coagulation and Fibrinolysis

Prevalence and Predictors of Venous Thromboembolism or Mortality in Hospitalized COVID-19 Patients

Stuart L. Cohen*
1  Department of Radiology, Northwell Health, Manhasset, New York, United States
2  Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
,
Eugenia Gianos*
3  Department of Cardiology, Northwell Health, Manhasset, New York, United States
,
Mathew A. Barish
1  Department of Radiology, Northwell Health, Manhasset, New York, United States
,
Saurav Chatterjee
3  Department of Cardiology, Northwell Health, Manhasset, New York, United States
4  Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, United States
,
Nina Kohn
2  Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
,
Martin Lesser
2  Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
4  Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, United States
,
Dimitrios Giannis
2  Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
4  Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, United States
,
Kevin Coppa
5  Department of Information Services, Northwell Health, New Hyde Park, New York, United States
,
Jamie S. Hirsch
2  Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
4  Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, United States
5  Department of Information Services, Northwell Health, New Hyde Park, New York, United States
,
Thomas G. McGinn
2  Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
4  Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, United States
,
Mark E. Goldin
2  Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
4  Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, United States
,
Alex C. Spyropoulos
2  Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, United States
4  Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, United States
,
for the Northwell Health COVID-19 Research Consortium› Author Affiliations
Funding This work was supported by the Association of University Radiologists GE Radiology Research Academic Fellowship (GERRAF) and Siemens Healthineers. S.L.C. received an honorarium for an educational presentation for Siemens Healthineers in 2020 and was a consultant for Infervision 2019. This work was also supported by the National Institute on Aging of the National Institutes of Health (R24AG064191) and the National Library of Medicine of the National Institutes of Health (R01LM012836).

Abstract

Background We aimed to identify the prevalence and predictors of venous thromboembolism (VTE) or mortality in hospitalized coronavirus disease 2019 (COVID-19) patients.

Methods A retrospective cohort study of hospitalized adult patients admitted to an integrated health care network in the New York metropolitan region between March 1, 2020 and April 27, 2020. The final analysis included 9,407 patients with an overall VTE rate of 2.9% (2.4% in the medical ward and 4.9% in the intensive care unit [ICU]) and a VTE or mortality rate of 26.1%. Most patients received prophylactic-dose thromboprophylaxis. Multivariable analysis showed significantly reduced VTE or mortality with Black race, history of hypertension, angiotensin converting enzyme/angiotensin receptor blocker use, and initial prophylactic anticoagulation. It also showed significantly increased VTE or mortality with age 60 years or greater, Charlson Comorbidity Index (CCI) of 3 or greater, patients on Medicare, history of heart failure, history of cerebrovascular disease, body mass index greater than 35, steroid use, antirheumatologic medication use, hydroxychloroquine use, maximum D-dimer four times or greater than the upper limit of normal (ULN), ICU level of care, increasing creatinine, and decreasing platelet counts.

Conclusion In our large cohort of hospitalized COVID-19 patients, the overall in-hospital VTE rate was 2.9% (4.9% in the ICU) and a VTE or mortality rate of 26.1%. Key predictors of VTE or mortality included advanced age, increasing CCI, history of cardiovascular disease, ICU level of care, and elevated maximum D-dimer with a cutoff at least four times the ULN. Use of prophylactic-dose anticoagulation but not treatment-dose anticoagulation was associated with reduced VTE or mortality.

Note

The data that support the findings of this study are available on request from http://[email protected]. The data are not publicly available due to restrictions as it could compromise the privacy of research participants. This was performed at Northwell Health.


* Both first authors contributed equally to the production of the manuscript.


Supplementary Material



Publication History

Received: 30 November 2020

Accepted: 18 January 2021

Publication Date:
20 January 2021 (online)

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