{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T07:17:25Z","timestamp":1763018245636,"version":"build-2065373602"},"reference-count":40,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2020,9,24]],"date-time":"2020-09-24T00:00:00Z","timestamp":1600905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biology"],"abstract":"<jats:p>The purpose of this study is to assess thrombotic risk in CoViD-19\/pneumonia patients with acute respiratory failure and to compare populations treated with three different antithrombotic prophylaxis protocols. The primary outcome is to analyze the prevalence of thrombotic events in hospitalized patients, while the secondary outcome is to analyze the correlation between different anticoagulation targets with thrombotic events. All patients referred to our hospital for acute respiratory failure due to COVID-19 pneumonia between 18 and 31 May 2020 were included. Seventy-four patients were enrolled (44 men and 30 women, average age 68.6). Diagnosis of venous thromboembolism was made in 21 cases (28.4%) and thrombotic events were associated with positive pressure ventilation support (p = 0.024) and hospitalization in ICU (p &lt; 0.0001). These patients presented higher levels of D-dimer (p &lt; 0.0001) and their hospital length of stay was &gt;16 days longer. Forty-seven out of 74 patients (63.5%) received intermediate or therapeutic dose of anticoagulation, while twenty-seven patients (34.5%) received standard antithrombotic prophylaxis. The analysis showed that an intermediate or therapeutic dose of anticoagulation did not decrease the prevalence of thrombotic events. On the other hand, six patients reported severe hemorrhagic complications. Despite intermediate or therapeutic-dose of anticoagulation, a high number of patients with acute respiratory failure secondary to COVID-19 developed thrombotic complications.<\/jats:p>","DOI":"10.3390\/biology9100310","type":"journal-article","created":{"date-parts":[[2020,9,25]],"date-time":"2020-09-25T01:39:33Z","timestamp":1600997973000},"page":"310","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Venous Thrombo-Embolism in Hospitalized SARS-CoV-2 Patients Treated with Three Different Anticoagulation Protocols: Prospective Observational Study"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8831-1361","authenticated-orcid":false,"given":"Yaroslava","family":"Longhitano","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizio","family":"Racca","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Zanza","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy"},{"name":"Department of Anesthesia, Critical Care and Emergency Medicine, Pietro and Michele Ferrero Hospital, 12051 Verduno-Alba, Italy"},{"name":"Department of Anesthesiology and Emergency Sciences, Policlinico Gemelli\/IRCCS-Catholic University of Sacred Heart, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Muncinelli","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Guagliano","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Peretti","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna Chiara","family":"Minerba","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9372-7767","authenticated-orcid":false,"given":"Marta","family":"Mari","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Boverio","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Salio","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guido","family":"Chichino","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Franceschi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Emergency Sciences, Policlinico Gemelli\/IRCCS-Catholic University of Sacred Heart, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5703-8737","authenticated-orcid":false,"given":"Andrea","family":"Piccioni","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Emergency Sciences, Policlinico Gemelli\/IRCCS-Catholic University of Sacred Heart, 00168 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5922-1524","authenticated-orcid":false,"given":"Ludovico","family":"Abenavoli","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Magnae Grecia University of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6528-4329","authenticated-orcid":false,"given":"Mauro","family":"Salvini","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Artico","sequence":"additional","affiliation":[{"name":"Department of Sensory Organs, Sapienza University of Rome Policlinico Umberto I, 00155 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1007\/s00134-020-05991-x","article-title":"Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China","volume":"46","author":"Ruan","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1515\/cclm-2020-0188","article-title":"Prominent changes in blood coagulation of patients with SARS-CoV-2 infection","volume":"58","author":"Han","year":"2020","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0140-6736(20)30211-7","article-title":"Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study","volume":"395","author":"Chen","year":"2020","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1111\/jth.14817","article-title":"Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy","volume":"18","author":"Tang","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1016\/S0140-6736(20)30937-5","article-title":"Endothelial cell infection and endotheliitis in COVID-19","volume":"395","author":"Varga","year":"2020","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1007\/s00134-020-06062-x","article-title":"CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis). High risk of thrombosis in patients with severe SARS-CoV-2 infection: A multicenter prospective cohort study","volume":"46","author":"Helms","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.thromres.2020.04.013","article-title":"Incidence of thrombotic complications in critically ill ICU patients with COVID-19","volume":"191","author":"Klok","year":"2020","journal-title":"Thromb. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.thromres.2020.05.018","article-title":"Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels","volume":"192","author":"Ji","year":"2020","journal-title":"Thromb. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2489","DOI":"10.3390\/jcm9082489","article-title":"Venous Thromboembolism among Hospitalized Patients with COVID-19 Undergoing Thromboprophylaxis: A Systematic Review and Meta-Analysis","volume":"9","author":"Chi","year":"2020","journal-title":"J. Clin. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1007\/s11239-020-02125-4","article-title":"Venous thromboembolism and heparin use in COVID-19 patients: Juggling between pragmatic choices, suggestions of medical societies and the lack of guidelines","volume":"50","author":"Porfidia","year":"2020","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1111\/jth.14810","article-title":"ISTH interim guidance on recognition and management of coagulopathy in COVID-19","volume":"18","author":"Thachil","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1055\/s-0040-1710019","article-title":"Prevention Treatment of VTE Associated with COVID-19 Infection Consensus Statement Group. Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines","volume":"120","author":"Zhai","year":"2020","journal-title":"Thromb. Haemost."},{"key":"ref_14","first-page":"9154","article-title":"Venous thromboembolism in critically ill patients affected by ARDS related to Covid-19 in northen-west Italy","volume":"24","author":"Longhitano","year":"2020","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1007\/s00134-020-06022-5","article-title":"Surviving Sepsis Campaign: Guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19)","volume":"46","author":"Alhazzani","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.thromres.2020.04.024","article-title":"Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy","volume":"191","author":"Lodigiani","year":"2020","journal-title":"Thromb. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2389","DOI":"10.1160\/TH17-08-0538","article-title":"Thrombus Burden of Deep Vein Thrombosis and Its Association with Thromboprophylaxis and D-Dimer Measurement: Insights from the APEX Trial","volume":"117","author":"Chi","year":"2017","journal-title":"Thromb. Haemost."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2950","DOI":"10.1016\/j.jacc.2020.04.031","article-title":"COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up","volume":"75","author":"Bikdeli","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"268","DOI":"10.7326\/M20-2003","article-title":"Autopsy findings and venous thromboembolism in patients with COVID-19: A prospective cohort study","volume":"173","author":"Wichmann","year":"2020","journal-title":"Ann. Intern Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"127","DOI":"10.5694\/j.1326-5377.1994.tb126557.x","article-title":"Autopsy evidence of pulmonary thromboembolism","volume":"160","author":"McKelvie","year":"1994","journal-title":"Med. J. Aust."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.jcrc.2005.09.014","article-title":"Burden of illness in venous thromboembolism in critical care: A multicenter observational study","volume":"20","author":"Patel","year":"2005","journal-title":"J. Crit. Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1007\/s00134-019-05565-6","article-title":"Extended-duration betrixaban versus shorter-duration enoxaparin for venous thromboembolism prophylaxis in critically ill medical patients: An APEX trial substudy","volume":"45","author":"Chi","year":"2019","journal-title":"Intensive Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1111\/jth.14830","article-title":"Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia","volume":"18","author":"Cui","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1161\/CIRCULATIONAHA.120.047430","article-title":"Lille ICU Haemostasis COVID-19 Group. Pulmonary Embolism in COVID-19 Patients: Awareness of an Increased Prevalence","volume":"142","author":"Poissy","year":"2020","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1111\/jth.14888","article-title":"Incidence of venous thromboembolism in hospitalized patients with COVID-19","volume":"18","author":"Middeldorp","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e2010478","DOI":"10.1001\/jamanetworkopen.2020.10478","article-title":"Venous Thrombosis Among Critically Ill Patients with Coronavirus Disease 2019 (COVID-19)","volume":"3","author":"Nahum","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1743","DOI":"10.1111\/jth.14869","article-title":"High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients","volume":"18","author":"Llitjos","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Santoliquido, A., Porfidia, A., Nesci, A., De Matteis, G., Marrone, G., Porceddu, E., Camm\u00e0, G., Giarretta, I., Fantoni, M., and Landi, F. (2020). Incidence of deep vein thrombosis among non-ICU patients hospitalized for COVID-19 despite pharmacological thromboprophylaxis. J. Thromb. Haemost.","DOI":"10.1111\/jth.14992"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s11239-020-02146-z","article-title":"Systematic assessment of venous thromboembolism in COVID-19 patients receiving thromboprophylaxis: Incidence and role of D-dimer as predictive factors","volume":"50","author":"Artifoni","year":"2020","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1111\/jth.14818","article-title":"Pulmonary thrombosis in 2019-nCoV pneumonia?","volume":"18","author":"Marongiu","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1055\/s-0039-1696942","article-title":"Pulmonary Thrombosis: A Clinical Pathological Entity Distinct from Pulmonary Embolism?","volume":"45","author":"Marongiu","year":"2019","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1002\/ajh.25829","article-title":"Hematological findings and complications of COVID-19","volume":"95","author":"Terpos","year":"2020","journal-title":"Am. J. Hematol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2000632","DOI":"10.1183\/13993003.00632-2020","article-title":"Early consensus management for non-ICU acute respiratory failure SARS-CoV-2 emergency in Italy: From ward to trenches","volume":"55","author":"Vitacca","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.4187\/respcare.01106","article-title":"The effects of flow on airway pressure during nasal high-flow oxygen therapy","volume":"56","author":"Parke","year":"2011","journal-title":"Respir. Care"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1378\/chest.15-0287","article-title":"VTE incidence and risk factors in patients with severe sepsis and septic shock","volume":"148","author":"Kaplan","year":"2015","journal-title":"Chest"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1053\/jcrc.2002.33941","article-title":"Venous thromboembolism and its prevention in critical care","volume":"17","author":"Geerts","year":"2002","journal-title":"J. Crit. Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.disamonth.2005.02.003","article-title":"Thrombosis risk assessment as a guide to quality patient care","volume":"51","author":"Caprini","year":"2005","journal-title":"Dis. Mon"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1007\/s11239-020-02145-0","article-title":"Heparin resistance in COVID-19 patients in the intensive care unit","volume":"50","author":"White","year":"2020","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1182\/blood.2020006000","article-title":"COVID-19 and its implications for thrombosis and anticoagulation","volume":"135","author":"Connors","year":"2020","journal-title":"Blood"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.thromres.2020.04.023","article-title":"Where do we stand with antithrombotic prophylaxis in patients with COVID-19?","volume":"191","author":"Ciavarella","year":"2020","journal-title":"Thromb. Res."}],"container-title":["Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-7737\/9\/10\/310\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:13:22Z","timestamp":1760177602000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-7737\/9\/10\/310"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,24]]},"references-count":40,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020,10]]}},"alternative-id":["biology9100310"],"URL":"https:\/\/doi.org\/10.3390\/biology9100310","relation":{},"ISSN":["2079-7737"],"issn-type":[{"type":"electronic","value":"2079-7737"}],"subject":[],"published":{"date-parts":[[2020,9,24]]}}}