Coronavirus disease 2019 combined with venous thromboembolism: Clinical features and prevention

Abstract

Objective: To analyze the clinical characteristics and control methods of coronavirus disease 2019 (COVID-19) complicated with venous thromboembolism(VTE), and to provide scientific basis for disease prevention, diagnosis and treatment. Methods: We retrospectively studied the cases of COVID-19 complicated with VTE in Renmin Hospital of Wuhan University from January 30, 2020 to March 19, 2020, and their clinical features, results of exmaninations, treatment methods, complications, and prognosis were reviewed. Results: Among the 1 448 COVID-19 patients, 17(1.17%) were VTE positive, 60-69 years old patients were more common. The main clinical types were critical (64.7%) and severe (35.7%) types. The main clinical symptoms were lower extremity swelling (70.6%) and pain (35.7%);58.8% of the patients had a history of high risk factors related to VTE. Most VTE patients were peripheral (58.8%) and involved bilateral limbs (41.2%). The proportion of neutrophils, D-dimer and fibrin degradation products at the last examination were lower than those on admission to the hospital, while the total number and proportion of lymphocytes were higher. Of the 17 VTE cases, 64.7% received venous catheterization, 58.8% received endotracheal intubation or tracheotomy, and 2 patients received extracorporeal membrane oxygenation (ECMO). The rate of bleeding was as high as 53%, and the risk of cardiovascular and cerebrovascular accidents was very high;the prognosis of the patients was poor, and the mortality rate was 23.5%. The cure rate was 17.6%, and the improvement rate was 47.1%. Two patients were still in critically ill. Conclusion: Venous thromboembolism was common in elderly COVID-19 patients with severe types and critical types. Most patients were male and characterized by atypical symptoms, and the early active VTE risk assessment and prevention procedures should be adopted. The risk for bleeding and cardiovascular/cerebrovascular accidents was high, although most cases had good outcomes after active treatment. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.