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April 23, 2020

Milan Report Shows “Urgent Need” to Improve Diagnostics and Study Prophylaxis for VTE in Ambulatory COVID-19 Patients

April 23, 2020—Corrado Lodigiani, MD, et al reported findings of venous and arterial thromboembolic complications in patients with the novel coronavirus (COVID-19) who were admitted to an academic hospital in Milan, Italy. The study is available online ahead of publication in the July issue of Thrombosis Research (2020;191:9–14). Dr. Lodigiani is from the Humanitas Research Hospital in Milan, Italy, and Istituto Clinico Humanitas at the Italian Ministry of Health.

The investigators studied 388 consecutive symptomatic patients with laboratory-proven COVID-19 who were admitted to a university hospital in Milan from February 2 to April 10, 2020. The patients’ median age was 66 years, 68% were men, and 16% required intensive care. Thromboprophylaxis was used in 100% of intensive care unit (ICU) patients and 75% of patients in the general ward.

The study’s primary outcome was any thromboembolic complication, including venous thromboembolism (VTE), ischemic stroke, and acute coronary syndrome (ACS)/myocardial infarction (MI). The secondary outcome was overt disseminated intravascular coagulation (DIC).

As reported in Thrombosis Research, thromboembolic events occurred in 28 patients (7.7% of closed cases; 95% confidence interval, 5.4%–11%), corresponding to a cumulative rate of 21% (ICU, 27.6%; general ward, 6.6%). Half of the thromboembolic events were diagnosed within 24 hours of hospital admission.

Additionally, the investigators found:

  • Of 44 patients who underwent VTE imaging tests, 16 patients (36%) had confirmed VTE.
  • Of 30 patients who underwent CT pulmonary angiography, 10 patients (33%) had confirmed pulmonary embolism.
  • The rate of ischemic stroke was 2.5%.
  • The rate of ACS/MI was 1.1%.
  • Overt DIC was present in eight patients (2.2%).

“The high number of arterial and, in particular, venous thromboembolic events diagnosed within 24 hours of admission and the high rate of positive VTE imaging tests among the few COVID-19 patients tested suggest that there is an urgent need to improve specific VTE diagnostic strategies and investigate the efficacy and safety of thromboprophylaxis in ambulatory COVID-19 patients,” concluded the investigators in Thrombosis Research.

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