Risk Of Venous Thrombosis In The Primary Care Setting During The Covid-19 Pandemic

Authors

  • Ana Azevedo-Cerqueira Family Medicine, USF Odisseia, Maia, Portugal
  • Pedro Torrão Pinheiro Family Medicine, USF Ponte Velha, Santo Tirso, Portugal https://orcid.org/0009-0009-0260-0070
  • Jaime Oliveira Family Medicine, USF Odisseia, Maia, Portugal https://orcid.org/0000-0002-2424-2392
  • Maria Manuel-Marques Family Medicine, USF Odisseia, Maia, Portugal
  • João Rocha-Neves Angiology and Vascular Surgery Department, Centro Hospitalar de São João, Porto, Portugal; Department of Biomedical sciences – Anatomy Unit, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Surgery, Faculdade de Medicina da Universidade do Porto, Portugal https://orcid.org/0000-0002-2656-8935

DOI:

https://doi.org/10.48729/pjctvs.310

Abstract

Aims: This study aimed to evaluate the variability of risk factors among patients with lower limb venous thrombosis, either Deep Vein Thrombosis (DVT) or Superficial Vein Thrombosis (SVT) in community patients with recent or current SARS-CoV-2 infection compared to a historical cohort.

Methods: We performed a historical retrospective analysis of all patients who presented to a primary health care unit and were diagnosed with DVT or SVT from January 2020 to December 2021. Historic controls were selected from January 2018 to December 2019. Demographic and clinical data were collected, including BMI, use of oral combined contraception, smoking status and date of COVID-19 infection diagnosis. Univariate analysis was performed for data assessment, including Chi-Square and ANOVA tests.

Results: Of the 8547 patients who attended a non-programmed consultation in the timeframe, seventy-nine patients (0.9%) were diagnosed with DVT (19) or SVT (60) and were included in the study. Their mean age was 57.3 ± 15.93 years, with a female-to-male ratio of 3.2 to 1. There was no significant association between COVID-19 and the development of DVT or SVT (p=0.151). However, there was a trend observed indicating a shift in the predominant gender in patients diagnosed with these conditions (85% females in 2018 versus 53.8% in 2021; p=0.077).

Conclusions: Outpatients seen by general practitioners during the pandemic of COVID-19 appear to present a trend towards an increased risk of combined DVT and SVT compared with patients of a historical cohort. Further studies are necessary to shed some light on this issue since robust evidence enables clinicians and policymakers to minimize venous thromboembolism risk in patients with SARS-CoV-2 infection.

Downloads

Download data is not yet available.

References

Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, et al. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic. J Am Coll Cardiol. 2020 May;75(18):2352–71.

Bangash MN, Patel J, Parekh D. COVID-19 and the liver: little cause for concern. Lancet Gastroenterol Hepatol. 2020 Jun;5(6):529–30.

Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. The Lancet. 2020 Mar;395(10229):1033–4.

Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P. Risk of Myocardial Infarction and Stroke after Acute Infection or Vaccination. N Engl J Med. 2004 Dec 16;351(25):2611–8.

Clayton TC, Gaskin M, Meade TW. Recent respiratory infection and risk of venous thromboembolism: case-control study through a general practice database. Int J Epidemiol. 2011 Jun

;40(3):819–27.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020 Feb;395(10223):507–13.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020 Feb;395(10223):497–506.

Panigada M, Bottino N, Tagliabue P, Grasselli G, Novembrino C, Chantarangkul V, et al. Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost. 2020 Jul;18(7):1738–42.

Maier CL, Truong AD, Auld SC, Polly DM, Tanksley CL, Duncan A. COVID-19-associated hyperviscosity: a link between inflammation and thrombophilia? The Lancet. 2020 Jun;395(10239):1758–9.

Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost. 2020 Jul;18(7):1559– 61.

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020 Apr;18(4):844–7.

Amgalan A, Othman M. Exploring possible mechanisms for COVID-19 induced thrombocytopenia: Unanswered questions. J Thromb Haemost. 2020 Jun;18(6):1514–6.

Burn E, Duarte-Salles T, Fernandez-Bertolin S, Reyes C, Kostka K, Delmestri A, et al. Venous or arterial thrombosis and deaths among COVID-19 cases: a European network cohort study. Lancet Infect Dis. 2022 May;S1473309922002237.

Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020 Jul;191:9–14.

Wichmann D, Sperhake JP, Lütgehetmann M, Steurer S, Edler C, Heinemann A, et al. Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study. Ann Intern Med. 2020 Aug 18;173(4):268–77.

Middeldorp S, Coppens M, Haaps TF, Foppen M, Vlaar AP, Müller MCA, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 2020 Aug;18(8):1995–2002.

Thoppil JJ, Courtney DM, McDonald S, Kabrhel C, Nordenholz KE, Camargo CA, et al. SARS-CoV-2 Positivity in Ambulatory Symptomatic Patients Is Not Associated With Increased Venous or Arterial Thrombotic Events in the Subsequent 30 Days. J Emerg Med. 2022 Jun;62(6):716–24.

Connors JM, Brooks MM, Sciurba FC, Krishnan JA, Bledsoe JR, Kindzelski A, et al. Effect of Antithrombotic Therapy on Clinical Outcomes in Outpatients With Clinically Stable Symptomatic COVID-19: The ACTIV-4B Randomized Clinical Trial. JAMA. 2021 Nov 2;326(17):1703–12.

ChenL,YuJ,HeW,ChenL,YuanG,DongF,etal.Riskfactors for death in 1859 subjects with COVID-19. Leukemia. 2020 Aug;34(8):2173–83.

Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020 Jun;18(6):1421–4.

Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers

DAMPJ, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020 Jul;191:145–7.

Malas MB, Naazie IN, Elsayed N, Mathlouthi A, Marmor R, Clary B. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis. EClinicalMedicine. 2020 Dec;29–30:100639.

Ren B, Yan F, Deng Z, Zhang S, Xiao L, Wu M, et al. Extremely High Incidence of Lower Extremity Deep Venous Thrombosis in 48 Patients With Severe COVID-19 in Wuhan. Circulation. 2020 Jul 14;142(2):181–3.

Zhang L, Feng X, Zhang D, Jiang C, Mei H, Wang J, et al. Deep Vein Thrombosis in Hospitalized Patients With COVID-19 in Wuhan, China: Prevalence, Risk Factors, and Outcome. Circulation. 2020 Jul 14;142(2):114–28.

Katsoularis I, Fonseca-Rodríguez O, Farrington P, Jerndal H, Lundevaller EH, Sund M, et al. Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study. BMJ. 2022 Apr 6;e069590.

Agarwal G, Hajra A, Chakraborty S, Patel N, Biswas S, Adler MK, et al. Predictors and mortality risk of venous thromboembolism in patients with COVID-19: systematic review and meta-analysis of observational studies. Ther Adv Cardiovasc Dis. 2022 Dec;16:17539447221105012.

Ierardi AM, Gaibazzi N, Tuttolomondo D, Fusco S, La Mura V, Peyvandi F, et al. Deep vein thrombosis in COVID-19 patients in general wards: prevalence and association with clinical and laboratory variables. Radiol Med (Torino). 2021 May;126(5):722–8.

Baccellieri D, Bertoglio L, Apruzzi L, Ardita V, D’Angelo A, Bossi M, et al. Incidence of deep venous thrombosis in COVID-19 hospitalized patients during the first peak of the Italian outbreak. Phlebol J Venous Dis. 2021 Jun;36(5):375–83.

Cohen KR, Anderson D, Ren S, Cook DJ. Contribution of the elevated thrombosis risk of males to the excess male mortality observed in COVID-19: an observational study. BMJ Open. 2022 Feb;12(2):e051624.

Christiansen SC, Lijfering WM, Helmerhorst FM, Rosendaal FR, Cannegieter SC. Sex difference in risk of recurrent venous thrombosis and the risk profile for a second event: Sex difference in recurrent venous thrombosis. J Thromb Haemost. 2010 Oct;8(10):2159–68.

Baglin T, Luddington R, Brown K, Baglin C. High risk of recurrent venous thromboembolism in men. J Thromb Haemost. 2004 Dec;2(12):2152–5.

Rodger MA, Kahn SR, Wells PS, Anderson DA, Chagnon I, Le Gal G, et al. Identifying unprovoked thromboembolism patients at low risk for recurrence who can discontinue anticoagulant therapy. Can Med Assoc J. 2008 Jul 17;179(5):417–26.

McRae S, Tran H, Schulman S, Ginsberg J, Kearon C. Effect of patient's sex on risk of recurrent venous thromboembolism: a meta-analysis. The Lancet. 2006 Jul;368(9533):371–8.

Douketis J, Tosetto A, Marcucci M, Baglin T, Cosmi B, Cushman M, et al. Risk of recurrence after venous thromboembolism in men and women: patient level meta-analysis. BMJ. 2011 Feb 24;342(feb24 2):d813–d813.

Braekkan SK, Borch KH, Mathiesen EB, Njolstad I, Wilsgaard T, Hansen JB. Body Height and Risk of Venous Thromboembolism: The Tromso Study. Am J Epidemiol. 2010 May 15;171(10):1109–15.

Aires A, Ferreira A, Santos A, Gonçalves R. Patologia aguda nos cuidados de saúde primários: um estudo transversal descritivo da realidade numa USF. Rev Port Clínica Geral. 2021 Jan 1;37(1):16–26.

Downloads

Published

04-04-2023

How to Cite

1.
Azevedo-Cerqueira A, Torrão Pinheiro P, Oliveira J, Manuel-Marques M, Rocha Neves J. Risk Of Venous Thrombosis In The Primary Care Setting During The Covid-19 Pandemic. Rev Port Cir Cardiotorac Vasc [Internet]. 2023 Apr. 4 [cited 2024 Nov. 24];30(1):43-7. Available from: https://pjctvs.com/index.php/journal/article/view/310

Issue

Section

Original Articles

Categories