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Vascular thrombosis during Covid-19 outbreak

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    By Katherine Kozlowski, Medical Author and Contributor to Vein News and www.VeinsVeinsVeins.com 

    I am reviewing an article that is of importance to the medical community and to patients in general who are diagnosed with Covid-19 infections regarding mortality related to thrombotic vascular complications in patients who get infected with Covid-19. 

    What was the purpose of the study?

    To determine the survival of patients hospitalized with covid-19 and who presented with vascular thrombotic complications.

    Who published this study? 

    The study was published by Gonzalez-Fajardo and colleagues from Servicio de Medicina Preventiva, Hospital Universitario 12 de Octubre, Madrid, Spain; Servicio de Medicina Preventiva, Hospital Universitario 12 de Octubre, Madrid, Spain; and Servicio de Cirugía Vascular, Hospital Universitario 12 de Octubre, Madrid, Spain. 

    The study was published in Med Clin Barcelona (see reference below). 

    What was the study type? 

    This was an observational study. 

    What were the study methods? 

    The authors investigated outcomes in consecutive patients with covid-19 who were treated during the months of March and April 2020 at the study institution. 

    All patients were symptomatic and the thrombotic event was objectively confirmed. 

    What were the thrombotic events that were studied? 

    Deep vein thrombosis (DVT)

    Pulmonary embolism (PE)

    Ischemic stroke

    Peripheral arterial thrombosis 

    What outcome measures were studied? 

    Survival curves for all groups were analyzed.

    What statistical methods were used to analyze the mortality data? 

    The Kaplan-Meier with log-rank test, and Cox regression.

    What were the results of the study?

    During the pandemic period from March 1 to April 30, 2020, 2943 patients were treated with confirmed covid-19 infections. 

    106 patients showed symptomatic vascular thrombosis.

    13 patients had peripheral arterial thrombosis

    15 patients had ischemic stroke

    20 patients had DVT 

    58 patients had pulmonary embolism

    Another 11 patients presented with multiple vascular thrombosis. 

    Arterial thrombosis patients were older than the average for this group which was 65 years old. 

    67.92% with vascular thrombosis were men. 

    What were the breakdowns for those that died from vascular thrombosis? 

    25 patients died during their hospital admission (23.58%).

    9 patients out of 13 for those with peripheral arterial thrombosis. 

    8 patients out of 15 for patients who suffered a stroke. 

    1 patient out of 20 who had a DVT

    7 patients out of 58 who had pulmonary embolism. 

    What were the study conclusions?

    Venous thromboembolic risk in Covid-19 infected patients is greater than the arterial thrombosis risk.

    When arterial thrombosis occurs, it is associated with high mortality rates.

    Survival was better in patients with DVT and PE than in patients with ischemic stroke or peripheral arterial thrombosis. 

    Reference:  Gonzales-Fajardo JA, Ansuategui M, Romero C, Comanges A, Gomez-Arbelaez D, Ibarra G and Garcia-Gutierrez A. Mortality of covid-19 patients with vascular thrombotic complications.  Med Clin (Barc) 2021; 156(3):112-117.

    Dr Karamanoukian's comment:  the authors make significant observations as Spain was one of the first European countries to suffer from the Covid-19 Pandemic in 2020. Practitioners should be vigilant to identify arterial and venous thrombosis in patients infected with Covid-19 and consider antithrombotic prophylaxis for hospitalized patients.