TY - JOUR
T1 - Acute arterial and deep venous thromboembolism in COVID-19 patients
T2 - Risk factors and personalized therapy
AU - Bozzani, Antonio
AU - Arici, Vittorio
AU - Tavazzi, Guido
AU - Franciscone, Mila Maria
AU - Danesino, Vittorio
AU - Rota, Monica
AU - Rossini, Rosa
AU - Sterpetti, Antonio V.
AU - Ticozzelli, Giulia
AU - Rumi, Elisa
AU - Mojoli, Francesco
AU - Bruno, Raffaele
AU - Ragni, Franco
PY - 2020
Y1 - 2020
N2 - Background: The Lombardy region suffered severely during the acute phase of the coronavirus diease 2019 outbreak in Italy (Mar–Apr 2020) with 16,000 diagnosed coronavirus disease 2019–related deaths (49% of the total coronavirus disease 2019–related deaths in Italy). In the area surrounding Pavia during the critical stage of the outbreak (Mar–Apr 2020), 1,225 of the documented 4,200 deaths were related to coronavirus disease 2019 infection, with a mortality rate of 181/100,000 inhabitants and an increase in deaths of 138% compared with the same period during previous years. Our aim was to report the experience of the Department of Vascular Surgery of Pavia (Lombardy, Italy), including the lessons learned and future perspectives regarding the management of coronavirus disease 2019 patients who developed severe acute ischemia with impending lower limb loss or deep vein thrombosis. Materials and Methods: We carried out a retrospective data collection of coronavirus disease 2019 patients with severe acute ischemia of the lower limbs or deep vein thrombosis, which we observed in our department during the period March 1, 2020, to April 30, 2020. Primary outcomes of the analysis were postoperative mortality for all patients and amputation rates only in those coronavirus disease 2019 patients suffering from acute lower limb ischemia. Secondary outcomes were the prevalence of the disease among admitted coronavirus disease 2019 patients, and any possible correlation among inflammatory parameters, thrombolytic status, and the presence of acute ischemia or deep vein thrombosis. Results: We observed 38 patients (28 male) with severe coronavirus disease 2019 infection (6 with lower limb arterial thrombosis and 32 with deep vein thrombosis). The median patient age was 64 years (range 30–94 y). In the arterial group, 3 had thrombosis on plaque and 3 on healthy arteries (“simple” arterial thrombosis). All underwent operative or hybrid (open/endo) revascularization; 1 patient died from major organ failure and 1 patient underwent major amputation. In the deep vein thrombosis group, 9 (28%) patients died from major organ failure, despite aggressive medical therapy. In patients with simple arterial thrombosis and those with deep vein thrombosis, we observed a decrease in inflammatory parameters (C-reactive protein) and in D-dimer and fibrinogen after aggressive therapy (P <.001). Conclusion: Our study confirms that critically ill, coronavirus disease 2019 patients who develop arterial and deep vein thrombosis have a high risk of mortality, but, if treated properly, there is an improvement in overall survival, especially in patients of 60 years of age or younger.
AB - Background: The Lombardy region suffered severely during the acute phase of the coronavirus diease 2019 outbreak in Italy (Mar–Apr 2020) with 16,000 diagnosed coronavirus disease 2019–related deaths (49% of the total coronavirus disease 2019–related deaths in Italy). In the area surrounding Pavia during the critical stage of the outbreak (Mar–Apr 2020), 1,225 of the documented 4,200 deaths were related to coronavirus disease 2019 infection, with a mortality rate of 181/100,000 inhabitants and an increase in deaths of 138% compared with the same period during previous years. Our aim was to report the experience of the Department of Vascular Surgery of Pavia (Lombardy, Italy), including the lessons learned and future perspectives regarding the management of coronavirus disease 2019 patients who developed severe acute ischemia with impending lower limb loss or deep vein thrombosis. Materials and Methods: We carried out a retrospective data collection of coronavirus disease 2019 patients with severe acute ischemia of the lower limbs or deep vein thrombosis, which we observed in our department during the period March 1, 2020, to April 30, 2020. Primary outcomes of the analysis were postoperative mortality for all patients and amputation rates only in those coronavirus disease 2019 patients suffering from acute lower limb ischemia. Secondary outcomes were the prevalence of the disease among admitted coronavirus disease 2019 patients, and any possible correlation among inflammatory parameters, thrombolytic status, and the presence of acute ischemia or deep vein thrombosis. Results: We observed 38 patients (28 male) with severe coronavirus disease 2019 infection (6 with lower limb arterial thrombosis and 32 with deep vein thrombosis). The median patient age was 64 years (range 30–94 y). In the arterial group, 3 had thrombosis on plaque and 3 on healthy arteries (“simple” arterial thrombosis). All underwent operative or hybrid (open/endo) revascularization; 1 patient died from major organ failure and 1 patient underwent major amputation. In the deep vein thrombosis group, 9 (28%) patients died from major organ failure, despite aggressive medical therapy. In patients with simple arterial thrombosis and those with deep vein thrombosis, we observed a decrease in inflammatory parameters (C-reactive protein) and in D-dimer and fibrinogen after aggressive therapy (P <.001). Conclusion: Our study confirms that critically ill, coronavirus disease 2019 patients who develop arterial and deep vein thrombosis have a high risk of mortality, but, if treated properly, there is an improvement in overall survival, especially in patients of 60 years of age or younger.
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U2 - 10.1016/j.surg.2020.09.009
DO - 10.1016/j.surg.2020.09.009
M3 - Article
AN - SCOPUS:85092190859
VL - 168
SP - 987
EP - 992
JO - Surgery
JF - Surgery
SN - 0039-6060
IS - 6
ER -