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COVID-19 Enfekte Hastalarda Tromboembolik Olayların Araştırılması

Year 2023, , 56 - 60, 28.02.2023
https://doi.org/10.54005/geneltip.1209433

Abstract

Amaç: Bu çalışmada, hastaneye yatırılan COVID-19 hastalarında tromboembolik olayların (TEE) sıklığının yanı sıra bu komplikasyonu yaşayan hastaların klinik sonuçları ve hasta özelliklerini belirlemeye çalıştık.
Gereç ve Yöntemler: Ocak 2020 ile Aralık 2021 tarihleri ​​arasında COVID-19 PCR testi pozitif olan tüm hastalar bu çalışmaya dahil edildi. COVID-19 tanısı ile TEE gelişen olguların verileri retrospektif olarak değerlendirildi.
Bulgular: Bu süre zarfında 2.845 yatan hasta COVID-19 ile başvurdu. Bu gruptan 96 hastada (%3,37) COVID-19 ile ilişkili TEE vardı. Ortalama yaş 63,76±13,85 (aralık, 28-80), 46 erkek (%47,92) ve 50 kadın (%52,08) idi. Hastaların 96'sından 46'sında (%47,92) şiddetli COVID-19, 50'sinde (%52,08) sadece hafif solunum semptomları vardı. Şiddetli COVID-19 grubu hastalar daha yaşlıydı ancak gruplar arasında istatistiksel olarak anlamlılık yoktu. Hafif COVID-19 grubunda periferik venöz hastalık daha sık görülürken, şiddetli COVID-19 grubunda periferik arter hastalığı daha yaygındı. Ağır COVID-19 hastalarında CRP, ürik asit, troponin, kreatinin, D-dimer ve lökosit seviyeleri daha yüksekti TEE ile (p<0.05). 96 olgunun 81'inde (%84,37) periferik venöz hastalık, 5'inde (%5,2) periferik arter hastalığı ve 11'inde (%11,45) pulmoner emboli vardı. Bir hastada (%1.04) hem periferik venöz hastalık hem de pulmoner emboli vardı. Genel mortalite %6.25 (6/96) idi.
Sonuç: COVID-19 ile ilişkili trombotik süreç, arterlerden daha sık damarları etkiler. COVID-19'da TEE için önemli gözlemlenen risk göz önüne alındığında, TEE için tanısal görüntüleme yüksek derecede klinik şüphe ile değerlendirilmelidir.

References

  • Vo TD, Daoud A, Jeney A, Andacheh I, Behseresht J, Hsu J,et al. COVID-19-related Peripheral Arterial Thrombosis Treated in a Large Health Maintenance Organization. Ann Vasc Surg. 2022;84:6-11.
  • Teuwen LA, Geldhof V, Pasut A, Carmeliet P. COVID-19: the vasculature unleashed. Nat Rev Immunol. 2020; 20:389.
  • Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020; 46:1089.
  • Abou Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management. Thromb Res. 2020;194:101-15.
  • Miesbach W, Makris M. COVID-19: Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation. Clin Appl Thromb Hemost. 2020;26.
  • Zuo Y, Estes SK, Ali RA, Gandhi AA, Yalavarthi S, Shi H, et al. Prothrombotic autoantibodies in serum from patients hospitalized with COVID-19. Sci Transl Med. 2020;12:570.
  • Al-Ani F, Chehade S, Lazo-Langner A. Thrombosis risk associated with COVID-19 infection. A scoping review. Thromb Res. 2020;192:152–60.
  • Huang C, Wang Y, Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China Lancet 2020;395(10223):497–506.
  • Danzi G B, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association? Eur Heart J. 2020;41(19):1858
  • Chen N, Zhou M, Dong X. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet.2020;395(10223):507–13.
  • Dobesh PP, Trujillo TC. Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID-19. Pharmacotherapy. 2020;40(11):1130-51.
  • Ozsu S, Gunay E, Konstantinides SV. A review of venous thromboembolism in COVID-19: A clinical perspective. Clin Respir J. 2021;15(5):506-12.
  • Indes JE, Koleilat I, Hatch AN, Choinski K, Jones DB, Aldailami H, et al. Early experience with arterial thromboembolic complications in patients with COVID-19. J Vasc Surg. 2021;73(2):381-9.
  • Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al; Global COVID-19 Thrombosis Collaborative Group, Endorsed by the ISTH, NATF, ESVM, and the IUA, Supported by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;75(23):2950-73.
  • Lagunas-Rangel FA. Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. J Med Virol. 2020; 92(10):1733-34.
  • Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE, Tan GB, Mucheli SS, Kuperan P, Ong KH. Hematologic parameters in patients with COVID-19 infection. Am J Hematol. 2020 ;95(6):131-4.
  • Alkan S, Şener A, Doğan E, Yüksel C, Yüksel B. Prophylactic Anticoagulant Treatment Might Have an Anti-inflammatory Effect and Reduce Mortality Rates in Hospitalized COVID-19 Patients? Oman Med J. 2022;37(4):394.
  • Barnes GD, Burnett A, Allen A, Blumenstein M, Clark NP, Cuker A, et al. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J Thromb Thrombolysis. 2020;50(1):72-81.
  • Dobesh P. The importance of appropriate prophylaxis for the prevention of venous thromboembolism in at‐risk medical patients. Int J Clin Pract. 2010;64:1554–62.
  • Attia J, Ray JG, Cook DJ, Douketis J, Ginsberg JS, Geerts WH. Deep vein thrombosis and its prevention in critically ill adults. Arch Intern Med. 2001;161:1268–79.
  • Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020;18:1421–4.
  • Zhang L, Feng X, Zhang D, Jiang C, Mei H, Wang J, et al. Deep Vein Thrombosis in Hospitalized Patients With COVID-19 in Wuhan, China: Prevalence, Risk Factors, and Outcome. Circulation. 2020;142(2):114-28.
  • Poissy J, Goutay J, Caplan M, Parmentier E, Duburcq T, Lassalle F, et al; Lille ICU Haemostasis COVID-19 Group. Pulmonary Embolism in Patients With COVID-19: Awareness of an Increased Prevalence. Circulation. 2020;142(2):184-6.
  • Beun R, Kusadasi N, Sikma M, Westerink J, Huisman A. Thromboembolic events and apparent heparin resistance in patients infected with SARS‐CoV‐2. Int J Lab Hematol.2020;42(1):19–20.
  • Demelo-Rodríguez P, Cervilla-Muñoz E, Ordieres-Ortega L, Parra-Virto A, Toledano-Macías M, Toledo-Samaniego N, et al. Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels. Thromb Res. 2020;192:23-6.
  • Maatman TK, Jalali F, Feizpour C, Douglas A 2nd, McGuire SP, Kinnaman G, et al. Routine Venous Thromboembolism Prophylaxis May Be Inadequate in the Hypercoagulable State of Severe Coronavirus Disease 2019. Crit Care Med. 2020;48(9):783-90.
  • Santoliquido A, Porfidia A, Nesci A, De Matteis G, Marrone G, Porceddu E, et al; GEMELLI AGAINST COVID-19 Group, D'Alfonso ME, Lo Monaco MR. Incidence of deep vein thrombosis among non-ICU patients hospitalized for COVID-19 despite pharmacological thromboprophylaxis. J Thromb Haemost. 2020;18(9):2358-63.
  • Criel M, Falter M, Jaeken J, Van Kerrebroeck M, Lefere I, Meylaerts L, et al. Venous thromboembolism in SARS-CoV-2 patients: only a problem in ventilated ICU patients, or is there more to it? Eur Respir J. 2020;56(1):200-1

Investigation of Thromboembolic Events in COVID-19 Infected Patients

Year 2023, , 56 - 60, 28.02.2023
https://doi.org/10.54005/geneltip.1209433

Abstract

Aim: In this study, we sought to determine patient characteristics and clinical outcomes of patients who experience this complication, as well as the frequency of thromboembolic events (TEE) in COVID-19 patients hospitalized.
Materials and Methods: Between January 2020 and December 2021, all the patients with positive COVID-19 PCR test results were enrolled in this study. The data of the cases that developed TEE with the diagnosis of COVID-19 were evaluated retrospectively.
Results:During this time, 2,845 inpatients were admitted with COVID-19. Among this group, 96 patients (3.37%) had COVID-19 - related TEE. The mean age was 63.76±13.85 years (range, 28–80 years) with 46 men (47.92%) and 50 women (52.08%). Of the patients, 46 of 96 (47.92%) had severe COVID-19, and 50 of 96 (52.08%) had only mild respiratory symptoms. Severe COVID-19 group patients were older but there was not statistically significance between the groups. Peripheral venous disease was more common in mild COVID-19 group, while peripheral arterial disease is more common in severe COVID-19 group.CRP, uric acid, troponin, creatinine,D-dimer and leukocyte levels were higher in severe COVID-19 patients with TEE (p<0.05). Peripheral venous disease was present in 81 of 96 (84.37%), peripheral arterial disease in 5 of 96 (5.2%), and pulmonary embolism in 11 (11.45%) cases. One patient (1.04%) had both peripheral venous disease and pulmonary embolism. The overall mortality was 6.25% (6/96).
Conclusion: COVID-19-associated thrombotic process affects more frequently veins than arteries. Given the significant observed risk for TEE in COVID-19, diagnostic imaging for TEE should be evaluated with a high degree of clinical suspicion.

References

  • Vo TD, Daoud A, Jeney A, Andacheh I, Behseresht J, Hsu J,et al. COVID-19-related Peripheral Arterial Thrombosis Treated in a Large Health Maintenance Organization. Ann Vasc Surg. 2022;84:6-11.
  • Teuwen LA, Geldhof V, Pasut A, Carmeliet P. COVID-19: the vasculature unleashed. Nat Rev Immunol. 2020; 20:389.
  • Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020; 46:1089.
  • Abou Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management. Thromb Res. 2020;194:101-15.
  • Miesbach W, Makris M. COVID-19: Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation. Clin Appl Thromb Hemost. 2020;26.
  • Zuo Y, Estes SK, Ali RA, Gandhi AA, Yalavarthi S, Shi H, et al. Prothrombotic autoantibodies in serum from patients hospitalized with COVID-19. Sci Transl Med. 2020;12:570.
  • Al-Ani F, Chehade S, Lazo-Langner A. Thrombosis risk associated with COVID-19 infection. A scoping review. Thromb Res. 2020;192:152–60.
  • Huang C, Wang Y, Li X. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China Lancet 2020;395(10223):497–506.
  • Danzi G B, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association? Eur Heart J. 2020;41(19):1858
  • Chen N, Zhou M, Dong X. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet.2020;395(10223):507–13.
  • Dobesh PP, Trujillo TC. Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID-19. Pharmacotherapy. 2020;40(11):1130-51.
  • Ozsu S, Gunay E, Konstantinides SV. A review of venous thromboembolism in COVID-19: A clinical perspective. Clin Respir J. 2021;15(5):506-12.
  • Indes JE, Koleilat I, Hatch AN, Choinski K, Jones DB, Aldailami H, et al. Early experience with arterial thromboembolic complications in patients with COVID-19. J Vasc Surg. 2021;73(2):381-9.
  • Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al; Global COVID-19 Thrombosis Collaborative Group, Endorsed by the ISTH, NATF, ESVM, and the IUA, Supported by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;75(23):2950-73.
  • Lagunas-Rangel FA. Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. J Med Virol. 2020; 92(10):1733-34.
  • Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE, Tan GB, Mucheli SS, Kuperan P, Ong KH. Hematologic parameters in patients with COVID-19 infection. Am J Hematol. 2020 ;95(6):131-4.
  • Alkan S, Şener A, Doğan E, Yüksel C, Yüksel B. Prophylactic Anticoagulant Treatment Might Have an Anti-inflammatory Effect and Reduce Mortality Rates in Hospitalized COVID-19 Patients? Oman Med J. 2022;37(4):394.
  • Barnes GD, Burnett A, Allen A, Blumenstein M, Clark NP, Cuker A, et al. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J Thromb Thrombolysis. 2020;50(1):72-81.
  • Dobesh P. The importance of appropriate prophylaxis for the prevention of venous thromboembolism in at‐risk medical patients. Int J Clin Pract. 2010;64:1554–62.
  • Attia J, Ray JG, Cook DJ, Douketis J, Ginsberg JS, Geerts WH. Deep vein thrombosis and its prevention in critically ill adults. Arch Intern Med. 2001;161:1268–79.
  • Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020;18:1421–4.
  • Zhang L, Feng X, Zhang D, Jiang C, Mei H, Wang J, et al. Deep Vein Thrombosis in Hospitalized Patients With COVID-19 in Wuhan, China: Prevalence, Risk Factors, and Outcome. Circulation. 2020;142(2):114-28.
  • Poissy J, Goutay J, Caplan M, Parmentier E, Duburcq T, Lassalle F, et al; Lille ICU Haemostasis COVID-19 Group. Pulmonary Embolism in Patients With COVID-19: Awareness of an Increased Prevalence. Circulation. 2020;142(2):184-6.
  • Beun R, Kusadasi N, Sikma M, Westerink J, Huisman A. Thromboembolic events and apparent heparin resistance in patients infected with SARS‐CoV‐2. Int J Lab Hematol.2020;42(1):19–20.
  • Demelo-Rodríguez P, Cervilla-Muñoz E, Ordieres-Ortega L, Parra-Virto A, Toledano-Macías M, Toledo-Samaniego N, et al. Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels. Thromb Res. 2020;192:23-6.
  • Maatman TK, Jalali F, Feizpour C, Douglas A 2nd, McGuire SP, Kinnaman G, et al. Routine Venous Thromboembolism Prophylaxis May Be Inadequate in the Hypercoagulable State of Severe Coronavirus Disease 2019. Crit Care Med. 2020;48(9):783-90.
  • Santoliquido A, Porfidia A, Nesci A, De Matteis G, Marrone G, Porceddu E, et al; GEMELLI AGAINST COVID-19 Group, D'Alfonso ME, Lo Monaco MR. Incidence of deep vein thrombosis among non-ICU patients hospitalized for COVID-19 despite pharmacological thromboprophylaxis. J Thromb Haemost. 2020;18(9):2358-63.
  • Criel M, Falter M, Jaeken J, Van Kerrebroeck M, Lefere I, Meylaerts L, et al. Venous thromboembolism in SARS-CoV-2 patients: only a problem in ventilated ICU patients, or is there more to it? Eur Respir J. 2020;56(1):200-1
There are 28 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Article
Authors

Serpil Şahin 0000-0001-8158-4594

Hatice Betül Altınışık 0000-0001-9273-0876

Sevil Alkan Çeviker 0000-0003-1944-2477

Uğur Küçük 0000-0003-4669-7387

Havva Yasemin Çinpolat 0000-0002-7161-2907

Uğur Gönlügür 0000-0001-8720-2788

Publication Date February 28, 2023
Submission Date November 24, 2022
Published in Issue Year 2023

Cite

Vancouver Şahin S, Altınışık HB, Alkan Çeviker S, Küçük U, Çinpolat HY, Gönlügür U. Investigation of Thromboembolic Events in COVID-19 Infected Patients. Genel Tıp Derg. 2023;33(1):56-60.