Risk factors associated with fatal thrombosis in hospitalized coronavirus disease 2019 (COVID-19) patients on anticoagulant therapy

Sholpan Kaliyeva; Yekaterina Yukhnevich; Zhanna Myasnikova; Natalya Simokhina; Nailya Dyussembaeva; Yuliya Bikbatyrova; Yelena Drobchenko; Torgin Sagadatova; Polina Semenikhina

doi:10.4103/jfcm.jfcm_60_23

Risk factors associated with fatal thrombosis in hospitalized coronavirus disease 2019 (COVID-19) patients on anticoagulant therapy

J Family Community Med. 2023 Oct-Dec;30(4):273-279. doi: 10.4103/jfcm.jfcm_60_23. Epub 2023 Oct 13.

Authors

Sholpan Kaliyeva¹, Yekaterina Yukhnevich¹, Zhanna Myasnikova¹, Natalya Simokhina¹, Nailya Dyussembaeva¹, Yuliya Bikbatyrova¹, Yelena Drobchenko², Torgin Sagadatova¹, Polina Semenikhina³

Affiliations

¹ Department of Clinical Pharmacology and Evidence-Based Medicine, NCJSC Karaganda Medical University, Karaganda, Kazakhstan.
² Department of Informatics and Biostatistics, NCJSC Karaganda Medical University, Karaganda, Kazakhstan.
³ Department of Neurology, NCJSC Karaganda Medical University, Karaganda, Kazakhstan.

Abstract

Background: The purpose of this study was to determine the factors that increase the risk of fatal thrombotic events in hospitalized coronavirus disease 2019 (COVID-19) patients receiving standard therapy according to the National Clinical Practice Guidelines (National Guidelines).

Materials and methods: In this case-control study, cases included 83 adults with COVID-19 who had died from thrombosis and controls comprised 83 COVID-19 patients with comparable criteria who survived. Data was abstracted by reviewing the medical records of selected patients and analyzed using Statistica. Parametric and non-parametric tests, as appropriate, were used to compare continuos variables between cases and controls, whereas Chi-square test was employed to compare categorical variables. Odds ratio (OR) was also calculated to measure the strength of association of case status and various independent variables.

Results: Fatal outcomes were higher in patients with chronic tubulointerstitial nephritis, (OR = 2.4, 95% CI 1.2-4.9); obesity, (OR = 2.1, 95% CI 0.5-8.6); and coronary heart disease (OR = 1.6, 95% CI 0.8-3.2). In the group with a D-dimer level from 250 to 1000 ng/ml, a statistically significant moderate positive correlation was found between the day of death and D-dimer level (P = 0.026). The lack of use of the PADUA Prediction Score for the risk of venous thromboembolism scale (PADUA Scale) and control of laboratory parameters (APTT and D-dimer) were associated with increased risk of fatal outcome. Overall, 19.2% cases and 8.4% of controls had no coagulation control; (OR = 2.6, 95% CI 1-6.7).

Conclusion: Chronic tubulointerstitial nephritis, obesity, and coronary heart disease were associatied with fatal thrombosis. A slight elevation of D-dimer level, lack of the PADUA Scale and laboratory monitoring in the management of hospitalized patients with COVID-19. was associated with an increased risk of thromboembolism.

Keywords: Coronavirus disease 2019; risk factors; thrombosis.