Multicenter Study

. 2025 Apr;58(4):485-496.

doi: 10.1007/s11239-025-03078-2. Epub 2025 Mar 10.

Predictors of venous thromboembolic events in hospitalized patients with COVID-19

Giovanni Scimeca^{1

2}, Darsiya Krishnathasan^{1

3}, Sina Rashedi^{1

3}, Zhou Lan^{1

4}, Alyssa Sato^{1

3}, Nada Hamade^{1

3}, Antoine Bejjani^{1

3}, Candrika D Khairani^{1

3}, Julia Davies^{1

3}, Nicole Porio^{1

3}, Ali A Assi^{3

5}, Andre Armero^{1

3}, Anthony Tristani^{1

3}, Marcos D Ortiz-Rios⁵, Victor Nauffal³, Zaid Almarzooq³, Eric Wei³, Valeria Zuluaga-Sánchez¹, Mehrdad Zarghami⁵, Aditya Achanta³, Sirus J Jesudasen⁶, Bruce Tiu¹, Geno J Merli⁷, Orly Leiva⁵, John Fanikos⁸, Aditya Sharma⁹, Samantha Rizzo¹, Mariana B Pfeferman¹, Ruth B Morrison^{1

3}, Alec Vishnevsky⁷, Judith Hsia^{10

11}, Mark R Nehler¹⁰, James Welker¹², Marc P Bonaca^{10

11}, Brett Carroll¹³, Samuel Z Goldhaber^{1

3}, Umberto Campia^{1

3}, Behnood Bikdeli^{1

3

14}, Gregory Piazza^{15

16}

Affiliations

¹ Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
² Mount Auburn Hospital, Harvard Medical School, Boston, MA, USA.
³ Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
⁴ Center for Clinical Investigation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁷ Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
⁸ Department of Pharmacy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁹ Department of Medicine, Cardiovascular Medicine, University of Virginia Health, Charlottesville, VA, USA.
¹⁰ CPC Clinical Research, Aurora, CO, USA.
¹¹ Department of Medicine, University of Colorado, Aurora, CO, USA.
¹² Anne Arundel Research Institute, Annapolis, MD, USA.
¹³ Smith Center for Cardiovascular Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
¹⁴ YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA.
¹⁵ Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. gpiazza@bwh.harvard.edu.
¹⁶ Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA. gpiazza@bwh.harvard.edu.

PMID: 40064840
DOI: 10.1007/s11239-025-03078-2

Multicenter Study

Predictors of venous thromboembolic events in hospitalized patients with COVID-19

Giovanni Scimeca et al. J Thromb Thrombolysis. 2025 Apr.

. 2025 Apr;58(4):485-496.

doi: 10.1007/s11239-025-03078-2. Epub 2025 Mar 10.

Authors

Affiliations

¹ Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
² Mount Auburn Hospital, Harvard Medical School, Boston, MA, USA.
³ Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
⁴ Center for Clinical Investigation, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁷ Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
⁸ Department of Pharmacy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁹ Department of Medicine, Cardiovascular Medicine, University of Virginia Health, Charlottesville, VA, USA.
¹⁰ CPC Clinical Research, Aurora, CO, USA.
¹¹ Department of Medicine, University of Colorado, Aurora, CO, USA.
¹² Anne Arundel Research Institute, Annapolis, MD, USA.
¹³ Smith Center for Cardiovascular Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
¹⁴ YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA.
¹⁵ Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. gpiazza@bwh.harvard.edu.
¹⁶ Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA. gpiazza@bwh.harvard.edu.

PMID: 40064840
DOI: 10.1007/s11239-025-03078-2

Abstract
in English, French

COVID-19 is associated with an increased risk of venous thromboembolism (VTE) in hospitalized patients. Although prior studies have attempted to identify predictors of VTE, restricted sample size and use of administrative claims data have limited such analyses. We utilized data from hospitalized patients in the CORONA-VTE Network, a United States multicenter registry of adult patients with PCR-confirmed COVID-19 (N = 3,844). The primary outcome was time-to-first event for a composite of adjudicated pulmonary embolism or deep vein thrombosis during 90-day follow-up. The candidate variables were selected by a priori clinical consensus. We conducted cause-specific Cox regression analysis adjusted for the selected variables for each imputed dataset and pooled the estimated HRs for reporting (p < 0.05 for significance). VTE occurred in 206 patients, with a cumulative incidence of 5.3% at 90 days. The covariates associated with increased risk of VTE were history of VTE (HR: 1.71; 95% CI: 1.11-2.63), corticosteroid therapy (HR: 1.76; 95% CI: 1.32-2.33) and known thrombophilia (HR: 3.56; 95% CI: 1.54-8.21) while therapeutic anticoagulation at baseline (HR: 0.42; 95% CI: 0.26-0.69), antecedent use of statins (HR: 0.67; 95% CI: 0.50-0.90), and prophylactic anticoagulation during hospitalization (HR: 0.52; 95% CI: 0.38-0.71) were associated with reduced risk of VTE. While prior VTE, corticosteroid therapy, and known thrombophilia were associated with an increased risk of VTE, prescriptions of prophylactic and therapeutic anticoagulation, and statins were associated with a decreased risk. Once externally validated, these findings may inform risk assessment in hospitalized patients with COVID-19.

Panel (a): Overall purpose of the study; Panel (b): Analytic approach to determine predictors of VTE; Panel (c): Final predictors.

Keywords: COVID-19; Coronavirus; Deep vein thrombosis; Embolism; Inpatients; Pulmonary; Risk factors; Venous thromboembolism.

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Conflict of interest statement

Declarations. Disclosures: Outside the submitted work, Dr. Bikdeli is supported by a Career Development Award from the American Heart Association and VIVA Physicians (#938814). Dr. Bikdeli was supported by the Scott Schoen and Nancy Adams IGNITE Award and is supported by the Mary Ann Tynan Research Scientist award from the Mary Horrigan Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital, and the Heart and Vascular Center Junior Faculty Award from Brigham and Women’s Hospital. Dr. Bikdeli reports that he was a consulting expert, on behalf of the plaintiff, for litigation related to two specific brand models of IVC filters. Dr. Bikdeli has not been involved in the litigation in 2022–2024 nor has he received any compensation in 2022–2024. Dr. Bikdeli reports that he is a member of the Medical Advisory Board for the North American Thrombosis Forum, and serves in the Data Safety and Monitory Board of the NAIL-IT trial funded by the National Heart, Lung, and Blood Institute, and Translational Sciences. Dr. Bikdeli is a collaborating consultant with the International Consulting Associates and the US Food and Drug Administration in a study to generate knowledge about utilization, predictors, retrieval, and safety of IVC filters. Dr. Bikdeli receives compensation as an Associated Editor for the New England Journal of Medicine Journal Watch Cardiology, as an Associate Editor for Thrombosis Research, and as an Executive Associate Editor for JACC, and is a Section Editor for Thrombosis and Haemostasis (no compensation). Dr. Piazza receives grant/research support paid to his institution from BMS/Pfizer, Janssen, Alexion, Bayer, Amgen, BSC, Esperion, and NIH 1R01HL164717-01 and consultant fees/honoraria from BSC, Amgen, BCRI, PERC, NAMSA, BMS, Janssen, and Regeneron. Competing interests: The authors declare no competing interests.

References

1. Nopp S et al (2020) Risk of venous thromboembolism in patients with COVID-19: A systematic review and meta-analysis. Res Pract Thromb Haemost 4(7):1178–1191. https://doi.org/10.1002/rth2.12439 - DOI - PubMed - PMC
1. Piazza G et al (2020) Registry of arterial and venous thromboembolic complications in patients with COVID-19. J Am Coll Cardiol 76(18):2060–2072. https://doi.org/10.1016/j.jacc.2020.08.070 - DOI - PubMed - PMC
1. Fang MC et al (2023) Assessment of the risk of venous thromboembolism in nonhospitalized patients with COVID-19. JAMA Netw Open 6(3):e232338. https://doi.org/10.1001/jamanetworkopen.2023.2338 - DOI - PubMed - PMC
1. Ortel TL et al (2020) American society of hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv 4(19):4693–4738. https://doi.org/10.1182/bloodadvances.2020001830 - DOI - PubMed - PMC
1. Piazza G, Morrow DA (2020) Diagnosis, management, and pathophysiology of arterial and venous thrombosis in COVID-19. JAMA 324(24):2548–2549. https://doi.org/10.1001/jama.2020.23422 - DOI - PubMed

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Predictors of venous thromboembolic events in hospitalized patients with COVID-19

Affiliations

Predictors of venous thromboembolic events in hospitalized patients with COVID-19

Authors

Affiliations

Abstract
in English, French

Conflict of interest statement

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Abstract in English, French

Conflict of interest statement

References

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MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Abstract
in English, French