• Clinics · Jan 2023

    Immunothrombosis and COVID-19 ‒ a nested post-hoc analysis from a 3186 patient cohort in a Latin American public reference hospital.

    • de LimaClarice AntunesCADivisao de Farmacia, Instituto Central, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil. Electronic address: clariceantunes@id.uff.br., Fabio Augusto Rodrigues Gonçalves, BesenBruno Adler Maccagnan PinheiroBAMPUnidade de Terapia Intensiva, Disciplina de Emergencias Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil., Antônio José Rodrigues Pereira, Sandro Félix Perazzio, Evelinda Marramon Trindade, Luiz Augusto Marcondes Fonseca, Nairo Massakazu Sumita, Vanusa Barbosa Pinto, DuarteAlberto José da SilvaAJDSDivisao de Laboratorio Central, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Laboratorio de Dermatologia e Imunodeficiencias (LIM56), Faculdade de Medicina FMUSP, Un, Carolina Broco Manin, and Arnaldo Lichtenstein.
    • Divisao de Farmacia, Instituto Central, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil. Electronic address: clariceantunes@id.uff.br.
    • Clinics (Sao Paulo). 2023 Jan 1; 78: 100178100178.

    ObjectiveCOVID-19 is associated with an elevated risk of thromboembolism and excess mortality. Difficulties with best anticoagulation practices and their implementation motivated the current analysis of COVID-19 patients who developed Venous Thromboembolism (VTE).MethodThis is a post-hoc analysis of a COVID-19 cohort, described in an economic study already published. The authors analyzed a subset of patients with confirmed VTE. We described the characteristics of the cohort, such as demographics, clinical status, and laboratory results. We tested differences amid two subgroups of patients, those with VTE or not, with the competitive risk Fine and Gray model.ResultsOut of 3186 adult patients with COVID-19, 245 (7.7%) were diagnosed with VTE, 174 (5.4%) of them during admission to the hospital. Four (2.3% of these 174) did not receive prophylactic anticoagulation and 19 (11%) discontinued anticoagulation for at least 3 days, resulting in 170 analyzed. During the first week of hospitalization, the laboratory most altered results were C-reactive protein and D-dimer. Patients with VTE were more critical, had a higher mortality rate, worse SOFA score, and, on average, 50% longer hospital stay.ConclusionProven VTE incidence in this severe COVID-19 cohort was 7.7%, despite 87% of them complying completely with VTE prophylaxis. The clinician must be aware of the diagnosis of VTE in COVID-19, even in patients receiving proper prophylaxis.Copyright © 2023 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.

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