• Saskia Middeldorp, Michiel Coppens, Thijs F van Haaps, Merijn Foppen, Alexander P Vlaar, Müller Marcella C A MCA https://orcid.org/0000-0002-5309-179X Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Catherine C S Bouman, Beenen Ludo F M LFM https://orcid.org/0000-0001-9204-1026 Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amster, Ruud S Kootte, Jarom Heijmans, Loek P Smits, Peter I Bonta, and Nick van Es.
• Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
• J. Thromb. Haemost. 2020 Aug 1; 18 (8): 1995-2002.

BackgroundCoronavirus disease 2019 (COVID-19) can lead to systemic coagulation activation and thrombotic complications.ObjectivesTo investigate the incidence of objectively confirmed venous thromboembolism (VTE) in hospitalized patients with COVID-19.MethodsSingle-center cohort study of 198 hospitalized patients with COVID-19.ResultsSeventy-five patients (38%) were admitted to the intensive care unit (ICU). At time of data collection, 16 (8%) were still hospitalized and 19% had died. During a median follow-up of 7 days (IQR, 3-13), 39 patients (20%) were diagnosed with VTE of whom 25 (13%) had symptomatic VTE, despite routine thrombosis prophylaxis. The cumulative incidences of VTE at 7, 14 and 21 days were 16% (95% CI, 10-22), 33% (95% CI, 23-43) and 42% (95% CI 30-54) respectively. For symptomatic VTE, these were 10% (95% CI, 5.8-16), 21% (95% CI, 14-30) and 25% (95% CI 16-36). VTE appeared to be associated with death (adjusted HR, 2.4; 95% CI, 1.02-5.5). The cumulative incidence of VTE was higher in the ICU (26% (95% CI, 17-37), 47% (95% CI, 34-58), and 59% (95% CI, 42-72) at 7, 14 and 21 days) than on the wards (any VTE and symptomatic VTE 5.8% (95% CI, 1.4-15), 9.2% (95% CI, 2.6-21), and 9.2% (2.6-21) at 7, 14, and 21 days).ConclusionsThe observed risk for VTE in COVID-19 is high, particularly in ICU patients, which should lead to a high level of clinical suspicion and low threshold for diagnostic imaging for DVT or PE. Future research should focus on optimal diagnostic and prophylactic strategies to prevent VTE and potentially improve survival.© 2020 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis.

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