The incidence of venous thromboembolism (VTE) is higher in Covid-19 patients compared to patients with community-acquired pneumonia (CAP), according to a new study from the United States reported in the Annals of American Thoracic Society.¹

Hendrickson et al retrospectively examined data from 7509 hospitalized Covid-positive patients, average age 57 years, from 23 hospitals in the state of Utah between January 1, 2020 and December 31, 2020. For the control group, 4304 patients, average age 67 years, with CAP from 16 of the 23 hospitals from January 1, 2017 to June 20, 2019 were selected. Imaging modalities like lower extremity doppler ultrasound, ventilation/perfusion (V/Q) scan, or computed tomography pulmonary angiogram (CTPA) were done for VTE 7 days before through 90 days following the first hospitalization date. The objective of the study was to compare the incidence of VTE among hospitalized patients with Covid-19 and CAP.

Results showed that testing rates were higher in CAP patients than in those with Covid-19; 43% vs 38%, respectively. But, tests for VTE were positive in 6.2% Covid-19 patients compared with nearly 4% of patients with CAP with an adjusted odds ratio of 1.64. The positivity rate for VTE was 16.3% for Covid-19 patients and 9.2% for patients with CAP.

Analysis of results of CTPA for pulmonary embolism (PE) showed positive diagnosis in 3.2% of Covid patients compared with 1.7% of CAP patients with aOR 1.99. Likewise, 3.3% Covid patients had deep vein thrombosis (DVT) on lower extremity Doppler, whereas this number was 2.5% in CAP patients. V/Q scan was positive in 0.2% of patients with Covid and 0.1% patients with CAP with aOR 1.40.

Hypercoagulopathy due to hyperinflammation induced by SARS-CoV-2 is the hallmark of Covid-19. This study has reiterated the high incidence of VTE, both PE and DVT, in Covid-19 patients compared to patients with CAP. It has also demonstrated lower testing rates for VTE in Covid patients than in CAP patients. According to the authors, the actual incidence of VTE in Covid-19 still uncertain, but their findings indicate that “VTE is more common in COVID-19 than in pneumonia caused by pathogens other than SARS-CoV-2”. They also highlight the need to test more Covid-19 patients for VTE.

Reference

1. Hendrickson KW, et al. Comparative frequency of venous thromboembolism in patients admitted to the hospital with SARS-CoV-2 infection vs. community-acquired pneumonia. Ann Am Thorac Soc. 2022 Mar 21. doi: 10.1513/AnnalsATS.202108-953RL.