May 31, 2020 COVID-19: Venous Thrombosis / Periop

May 31, 2020
COVID-19: Venous Thrombosis / Perioperative Infection / Comorbid Diabetes / Early NYC Patients

By Amy Orciari Herman
Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

Check out some of the latest findings on novel coronavirus disease

(COVID-19):
Venous thrombosis: Deep vein thrombosis was identified in 65% of 34 COVID-19 patients who underwent venous ultrasound upon admission to a French intensive care unit, researchers report in JAMA Network Open. When second ultrasounds performed 48 hours after ICU admission were included, the prevalence rose to 79%. Of note, all patients had received anticoagulant prophylaxis at hospital admission. The researchers say that "prognosis might be improved with early detection and a prompt start of anticoagulant therapy."

Perioperative infection: Surgery in patients with perioperative SARS-CoV-2 infection carries a high 30-day mortality rate, largely due to pulmonary complications, a Lancet study finds. Researchers examined outcomes in over 1100 patients who underwent surgery in 235 hospitals across 24 countries. All had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. Overall, mortality within 30 days of surgery was 24%. The mortality rate was higher in men, older patients, those undergoing emergency procedures, and those having major surgeries. Roughly half the cohort developed at least one pulmonary complication, and 38% of these patients died — accounting for 83% of all deaths in the entire cohort. The researchers conclude: "Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery."

Comorbid diabetes: Roughly 1 in 10 COVID-19 patients with diabetes dies within 7 days of hospital admission, according to a study in Diabetologia. The analysis included over 1300 diabetics with COVID-19 admitted to French hospitals in March. Some 29% required intubation or died within 7 days (the primary composite outcome), and body-mass index was the only variable independently associated with this outcome. Roughly 18% of the patients were discharged by day 7.

Early NYC patients: Of the first 1000 COVID-19 patients admitted to a New York City hospital, 34% developed acute kidney injury and 14% required dialysis, researchers report in The BMJ. Over 90% of the cohort had major comorbidities at baseline. Roughly a quarter of patients were admitted to the ICU, and about one fifth overall died. Patients' first intubations occurred most commonly at 3–4 days and at 9 days after symptom onset — which, the researchers say, "could suggest a biphasic nature" of the disease course. The median length of invasive ventilation was 6 days in patients who died, 9 days in patients who were discharged, and 29 days in those who were still hospitalized at the end of follow-up.

LINK(S):

Venous thrombosis findings in JAMA Network Open (Free)

Perioperative infection findings in the Lancet (Free)

Comorbid diabetes findings in Diabetologia (Free PDF)

Early NYC findings in The BMJ (Free)

NEJM Journal Watch COVID-19 page (Free)

NEJM COVID-19 page (Free)

https://www.jwatch.org/fw116691/2020/05/31/co...&jspc=