Risk assessment of venous thromboembolism and bleeding in COVID-19 patients

Background The coronavirus disease 2019 (COVID-19) is a newly recognized illness that has spread rapidly all over the world. Severe hypoxemic respiratory failure from COVID-19 will bring high risk of venous thromboembolism (VTE). Our study aims to identify in-hospital VTE risk and bleeding risk in COVID-19 patients. Methods We retrospectively studied 138 consecutively enrolled patients with COVID-19 and identified in-hospital VTE and bleeding risk by Padua Prediction Score and Improve bleed risk assessment model. The clinical data and features were analyzed in VTE patients. Results Our findings identified that 23 (16.67%) patients with COVID-19 were at high risk for VTE according to Padua prediction score, and 9(6.52%) patients were at high risk of bleeding for VTE prophylaxis according to Improve prediction score. Fifteen critically ill patients faced double high risk from thrombosis (Padua score more than 4 points in all 15[100%] patients) and hemorrhage (Improve score more than 7 points in 9[60.0%] patients). Thrombotic events were identified in four patients (2.9%) of all COVID-19 patients. All of them were diagnosed as deep vein thrombosis by ultrasound after 3 to 18 days after admission. Three (75.0%) were critically ill patients, which means the incidence of VTE among critically ill patients was 20%. One major hemorrhage was happened in critically ill patients during VTE treatment. Conclusion Critically ill patients with COVID-19 suffered both high risk of thrombosis and bleeding risks. More effective VTE prevention strategies based on an individual assessment of bleeding risks were necessary for critically ill patients with COVID-19.