Risk factors associated with fatal thrombosis in hospitalized coronavirus disease 2019 (COVID-19) patients on anticoagulant therapy

Abstract

BACKGROUND: The purpose of this study was to determine the factors that increase the risk of fatal thrombotic events in hospitalized coronavirus disease 2019 (COVID-19) patients receiving standard therapy according to the National Clinical Practice Guidelines (National Guidelines). MATERIALS AND METHODS: In this case–control study, cases included 83 adults with COVID-19 who had died from thrombosis and controls comprised 83 COVID-19 patients with comparable criteria who survived. Data was abstracted by reviewing the medical records of selected patients and analyzed using Statistica. Parametric and non-parametric tests, as appropriate, were used to compare continuos variables between cases and controls, whereas Chi-square test was employed to compare categorical variables. Odds ratio (OR) was also calculated to measure the strength of association of case status and various independent variables. RESULTS: Fatal outcomes were higher in patients with chronic tubulointerstitial nephritis, (OR = 2.4, 95% CI 1.2–4.9); obesity, (OR = 2.1, 95% CI 0.5–8.6); and coronary heart disease (OR = 1.6, 95% CI 0.8–3.2). In the group with a D-dimer level from 250 to 1000 ng/ml, a statistically significant moderate positive correlation was found between the day of death and D-dimer level ( P = 0.026). The lack of use of the PADUA Prediction Score for the risk of venous thromboembolism scale (PADUA Scale) and control of laboratory parameters (APTT and D-dimer) were associated with increased risk of fatal outcome. Overall, 19.2% cases and 8.4% of controls had no coagulation control; (OR = 2.6, 95% CI 1–6.7). CONCLUSION: Chronic tubulointerstitial nephritis, obesity, and coronary heart disease were associatied with fatal thrombosis. A slight elevation of D-dimer level, lack of the PADUA Scale and laboratory monitoring in the management of hospitalized patients with COVID-19. was associated with an increased risk of thromboembolism.