Table 2.
Evidence of thrombotic events in COVID-19
| Reported in | Number of patients with events | Manifestation | Major findings | Remarks |
|---|---|---|---|---|
| Italy [42] | 6 | Stroke | Both ischemic (4) and haemorrhagic (2) strokes reported; median age 69 years | Five had pre-existing vascular risk factors |
| New York, US [43] | 32 | Ischemic stroke | Out of 3556 hospitalised patients with diagnoses of COVID-19 infection, 32 patients (0.9%) had imaging proven ischemic stroke | Most strokes were cryptogenic, possibly related to an acquired hypercoagulability, and mortality was increased |
| Sakarya, Turkey [44] | 4 | Ischemic stroke | All had symptomatic COVID-19 infection; Three patients have elevated D-dimer levels, and two of them had high C-reactive protein (CRP) levels | Stroke developed simultaneously with the diagnosis of COVID-19 |
| London, UK [45] | 6 | Ischemic stroke |
All had raised D-dimer and large vessel occlusion 3 had multi-territory infarcts, 2 had concurrent venous thrombosis |
Ischemic strokes occurred despite therapeutic anticoagulation in two patients |
| New York, US [46] | 33 | Stroke patients detected to have COVID-19 | 28% (33/118) had COVID-19 related lung findings. RT-PCR was positive for COVID-19 in 93.9% (31/33) of these | Retrospective review of COVID-19 related findings in the lung apices of CTA done for stroke evaluation |
| New York, US [47] | 4 | Ischemic stroke | All large vessel thrombus | All had strokes during the early stages of COVID-19 |
| Milan, Italy [48] | 28 | 10 pulmonary thromboembolism; VTE 16; stroke 9; ACS 4 | Thromboembolic events occurred in 28 (7.7%); VTE was confirmed in 16 (36%) | Overt DIC was present in 8 (2.2%) |
| Paris, France [49] | 18 | 18 VTE including 6 pulmonary embolism |
Out of 26 screened for VTE in 2 centres, 18 were positive. Most had hypertension, high BMI and were on mechanical ventilation. |
High rate of thromboembolic events even in patients on therapeutic anticoagulation |
| Amsterdam, The Netherlands [50] | 39 | VTE | 39 patients (20%) out of 75 admitted to intensive care had VTE despite routine thrombosis prophylaxis | Cumulative incidence of VTE at day 21 was 42% (95% CI 30–54) |
| The Netherlands [51] | 75 | 65 pulmonary embolism; 5 ischemic strokes; 5 others | Out of 184 ICU patients, 75 had thromboembolic events and 41 died | Patients diagnosed with thrombotic complications were at higher risk of all-cause death, for an HR of 5.4 (95%CI 2.4–12) |
| Detroit, US [52] | 72 | Pulmonary embolism | Out of 337 COVID-19 patients who had CTA, 72(20%) had pulmonary embolism | In multivariate analysis, statins were protective while high BMI and D-dimer levels predicted pulmonary embolism |
| Brighton, UK [22] | 21 | VTE | 21/274 (7.7%) COVID-19 patients were diagnosed with VTE. Most COVID-19 patients had elevated (> 0.5 μg/mL) D-dimers | Higher rates of VTE in patients who had turned PCR negative |
| Strasbourg, France [53] | 64 | 25 pulmonary embolism; 4 strokes | Comparison with non-COVID-19 ARDS patients (n = 145) confirmed that COVID-19 ARDS patients (n = 77) developed significantly more thrombotic complications, mainly pulmonary embolisms (11.7 vs 2.1%, p < 0.008) | Many patients with ARDS secondary to COVID-19 developed life-threatening thrombotic complications despite anticoagulation |
| Besancon, France [54] | 23 | Pulmonary embolism | Out of 280 patients hospitalised for COVID-19, 100 had CTA of which 23 turned out to have pulmonary embolism | Pulmonary embolus was diagnosed at mean of 12 days from symptom onset |
| Paris, France [55] | 32 | Pulmonary embolism | 137 CTA of COVID-1 positive cases revealed 32 cases of pulmonary embolism | Prophylactic anticoagulation did not avoid the occurrence of PE in hospitalised patients |
| New York, USA [56] | 3 | Pulmonary embolism | All had comorbidities; survived with enoxaparin/rivaroxaban | All had persistent hypoxemia |
| Strasbourg, France [57] | 32 | Pulmonary embolism | Thirty-two of 106 patients with COVID-19 infection were positive for acute pulmonary embolus on CTA | Rate higher than usually encountered in critically ill patients without COVID-19 infection |
COVID-19 Coronavirus-2019 disease; RT-PCR real time-polymerase chain reaction; CTA computerized tomography with angiography; DIC disseminated intravascular coagulation; VTE venous thromboembolism; ACS acute coronary syndrome; BMI body mass index; HR hazard ratio; PE pulmonary embolism