Arterial and venous thrombosis in coronavirus 2019 disease (Covid‐19)

Relationship with mortality

Francesco Violi, Giancarlo Ceccarelli, Roberto Cangemi, Francesco Cipollone, Damiano D’Ardes, Alessandra Oliva, Matteo Pirro, Monica Rocco, Francesco Alessandri, Gabriella D’Ettorre, Miriam Lichtner, Pasquale Pignatelli, Domenico Ferro, Franco Ruberto, Gregory Y. H. Lip, Francesco Pugliese, Claudio Maria Mastroianni, Intensive Care, Infectious Diseases COVID-19 Study Group of Sapienza University


Background: Patients with coronavirus disease 2019 (Covid-19) may experience venous thrombosis while data regarding arterial thrombosis are sparse.

Methods: Prospective multicenter study in 5 hospitals including 373 patients with Covid-19-related pneumonia. Demographic data, laboratory findings including coagulation tests and comorbidities were reported. During the follow-up any arterial or venous thrombotic events and death were registered.

Results: Among 373 patients, 75 (20%) had a thrombotic event and 75 (20%) died. Thrombotic events included 41 venous thromboembolism and 34 arterial thrombosis. Age, cardiovascular disease, intensive care unit treatment, white blood cells, D-dimer, albumin and troponin blood levels were associated with thrombotic events. In a multivariable regression logistic model, intensive care unit treatment (Odds Ratio [OR]: 6.0; 95% Confidence Interval [CI] 2.8-12.6; p < 0.001); coronary artery disease (OR: 2.4; 95% CI 1.4-5.0; p = 0.022); and albumin levels (OR: 0.49; 95% CI 0.28-0.87; p = 0.014) were associated with ischemic events. Age, sex, chronic obstructive pulmonary disease, diabetes, heart failure, coronary heart disease, intensive care unit treatment, in-hospital thrombotic events, D-dimer, C-reactive protein, troponin, and albumin levels were associated with mortality. A multivariable Cox regression analysis showed that in-hospital thrombotic events (hazard ratio [HR]: 2.72; 95% CI 1.59-4.65; p < 0.001), age (HR: 1.035; 95% CI 1.014-1.057; p = 0.001), and albumin (HR: 0.447; 95% CI 0.277-0.723; p = 0.001) predicted morality.

Conclusions: Covid-19 patients experience an equipollent rate of venous and arterial thrombotic events, that are associated with poor survival. Early identification and appropriate treatment of Covid-19 patients at risk of thrombosis may improve prognosis.

Keywords: Covid-19, Mortality, SARS-cov-2, Thrombosis.

Internal and Emergency Medicine. 2021; 16(5): 1231–1237
DOI: 10.1007/s11739-020-02621-8.
© 2021. The Author(s).