Arterial and venous thrombosis in coronavirus 2019 disease (Covid-19): relationship with mortality
Authors: Violi Francesco , Ceccarelli Giancarlo , Cangemi Roberto , Cipollone Francesco , D’Ardes Damiano , Oliva Alessandra , Pirro Matteo , Rocco Monica , Alessandri Francesco , D’Ettorre Gabriella , Lichtner Miriam , Pignatelli Pasquale , Ferro Domenico , Ruberto Franco , Lip Gregory Y. H. , Pugliese Francesco , Mastroianni Claudio Maria ,   the Intensive Care, Infectious Diseases COVID-19 Study Group of Sapienza University, Pugliese Francesco , Alessandri Francesco , Ruberto Franco , Albante Alida , Auricchio Daniela , De Lazzaro Francesco , M. De Lauri Daniela , Di Santo Carmela , Ianni Stefano , Magnanimi Eugenia , Ratini Fabiola , Sabani Anna , Titi Luca , Vaccaro Paola , Giordano Giovanni , Manganelli Chiara , Mancone Massimo , Bruno Katia , Celli Paola , Consolo Stella , Croce Claudia , Giannetti Lorena , Martelli Sabina , Messina Teresa , Pattelli Elisa , Perrella Serena , Portieri Monica , Ricci Claudia , Almenrader Nicole , Arzilla Roberto , Delia Emilia , Di Giovanni Claudio , Laderchi Amalia , Macrì Carlotta , Marandola Maurizio , Nardecchia Giada , Pacilli Massimo , Pacini Francesca , Araimo Morselli Fabio , Imperiale Carmela , Tordiglione Paolo , Mastroianni Claudio Maria , Ciardi Maria Rosa , Ajassa Camilla , D’Ettorre Gabriella , Lichtner Miriam , D’Agostino Claudia , Russo Gianluca , Trinchieri Vito , Guariglia Paola , Antonelli Laura , Oliva Alessandra , Cuomo Rosaria Maria , Carnevalini Martina , Mastropietro Cristina , Iaiani Giancarlo , Mezzaroma Ivano , Falciano Mario , Ceccarelli Giancarlo , Brogi Andrea , Celani Luigi , Cavallari Nelson Eugenio , Rivano Capparuccia Marco , Massetti Anna Paola , Fimiani Caterina , Santori Marta , Bianchi Alessandro , Franchi Cristiana , De Angelis Maurizio , Sereno Silvia , Furlan Caterina , De Sanctis Giuseppe , Paoletti Francesca , Pasculli Patrizia , Cogliati Dezza Francesco , Vassalini Paolo , Cancelli Francesca , De Girolamo Gabriella , Savelloni Giulia , Valeri Serena , Siccardi Guido , Alessi Federica , Recchia Gregorio , Ridolfi Marco , Romani Francesco Eugenio , Aronica Raissa , Filippi Valeria , Vera Mauro , Volpicelli Lorenzo , Candy Matteo , Alban Rugova , Di Bari Silvia , Gavaruzzi Francesca , Casali Elena , Carli Maria Serena , Zingaropoli Antonella Maria , Perri Valentina , De Angelis Massimiliano , Santinelli Letizia , Pinacchio Claudia , Nijhawan Parni , Miele Claudia Maria , Innocenti Pietro Giuseppe , Mengoni Fabio 
Published: July 2021

Abstract
Background
Patients with coronavirus disease 2019 (Covid-19) may experience venous thrombosis while data regarding arterial thrombosis are sparse.

Methods
Prospective multicenter study in 5 hospitals including 373 patients with Covid-19-related pneumonia. Demographic data, laboratory findings including coagulation tests and comorbidities were reported. During the follow-up any arterial or venous thrombotic events and death were registered.

Results
Among 373 patients, 75 (20%) had a thrombotic event and 75 (20%) died. Thrombotic events included 41 venous thromboembolism and 34 arterial thrombosis. Age, cardiovascular disease, intensive care unit treatment, white blood cells, D-dimer, albumin and troponin blood levels were associated with thrombotic events. In a multivariable regression logistic model, intensive care unit treatment (Odds Ratio [OR]: 6.0; 95% Confidence Interval [CI] 2.8–12.6; p < 0.001); coronary artery disease (OR: 2.4; 95% CI 1.4–5.0; p = 0.022); and albumin levels (OR: 0.49; 95% CI 0.28–0.87; p = 0.014) were associated with ischemic events. Age, sex, chronic obstructive pulmonary disease, diabetes, heart failure, coronary heart disease, intensive care unit treatment, in-hospital thrombotic events, D-dimer, C-reactive protein, troponin, and albumin levels were associated with mortality. A multivariable Cox regression analysis showed that in-hospital thrombotic events (hazard ratio [HR]: 2.72; 95% CI 1.59–4.65; p < 0.001), age (HR: 1.035; 95% CI 1.014–1.057; p = 0.001), and albumin (HR: 0.447; 95% CI 0.277–0.723; p = 0.001) predicted morality.

Conclusions
Covid-19 patients experience an equipollent rate of venous and arterial thrombotic events, that are associated with poor survival. Early identification and appropriate treatment of Covid-19 patients at risk of thrombosis may improve prognosis.