• Sònia Jiménez, Òscar Miró, Pere Llorens, Francisco J Martín-Sánchez, Guillermo Burillo-Putze, Pascual Piñera, Alfonso Martín, Aitor Alquézar, Eric J García-Lamberechts, Javier Jacob, María L L Grima, Javier Millán, Francisca Molina, Patricia B Albero, Carlos Cardozo, Josep M Mòdol, Alfons Aguirre, Ruth Gaya, María Adroher, Lluís Llauger, Juan J L Díaz, Nayra C González, Paula L Aragües, Ana P Gómez, Juan G Del Castillo, and Spanish Investigators on Emergency Situations TeAm (SIESTA) network.
• Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia.
• Eur J Emerg Med. 2021 Jun 1; 28 (3): 218226218-226.

Background And ImportanceA higher incidence of venous thromboembolism [both pulmonary embolism and deep vein thrombosis (DVT)] in patients with coronavirus disease 2019 (COVID-19) has been described. But little is known about the true frequency of DVT in patients who attend emergency department (ED) and are diagnosed with COVID-19.ObjectiveWe investigated the incidence, risk factors, clinical characteristics and outcomes of DVT in patients with COVID-19 attending the ED before hospitalization.MethodsWe retrospectively reviewed all COVID patients diagnosed with DVT in 62 Spanish EDs (20% of Spanish EDs, case group) during the first 2 months of the COVID-19 outbreak. We compared DVT-COVID-19 patients with COVID-19 without DVT patients (control group). Relative frequencies of DVT were estimated in COVID and non-COVID patients visiting the ED and annual standardized incidences were estimated for both populations. Sixty-three patient characteristics and four outcomes were compared between cases and controls.ResultsWe identified 112 DVT in 74 814 patients with COVID-19 attending the ED [1.50‰; 95% confidence interval (CI), 1.23-1.80‰]. This relative frequency was similar than that observed in non-COVID patients [2109/1 388 879; 1.52‰; 95% CI, 1.45-1.69‰; odds ratio (OR) = 0.98 [0.82-1.19]. Standardized incidence of DVT was higher in COVID patients (98,38 versus 42,93/100,000/year; OR, 2.20; 95% CI, 2.03-2.38). In COVID patients, the clinical characteristics associated with a higher risk of presenting DVT were older age and having a history of venous thromboembolism, recent surgery/immobilization and hypertension; chest pain and desaturation at ED arrival and some analytical disturbances were also more frequently seen, d-dimer >5000 ng/mL being the strongest. After adjustment for age and sex, hospitalization, ICU admission and prolonged hospitalization were more frequent in cases than controls, whereas mortality was similar (OR, 1.37; 95% CI, 0.77-2.45).ConclusionsDVT was an unusual form of COVID presentation in COVID patients but was associated with a worse prognosis.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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