This retrospective cohort study evaluated the incidence, anatomical distribution, independent predictors, and clinical outcomes of DVT in 5,831 COVID-19 hospitalizations at a Brazilian tertiary center from 2020–2024.
DVT was associated with markedly worse outcomes: in-hospital mortality 37.7% vs. 11.1% (p<0.001), median LOS 24 vs. 8 days (p<0.001), and PE rate 15.9% vs. 1.2% (p<0.001). Strongest independent predictor was prior DVT (aOR 18.3; 95% CI 5.22–63.9), followed by oxygen requirement (aOR 4.86), obesity (aOR 3.21), and smoking (aOR 2.59). Most DVT events were acute and left lower extremity–predominant.
- Retrospective single-center design limits generalizability beyond Brazilian tertiary settings. - DVT incidence may be underestimated as screening was not universal (venous Doppler performed selectively). - Confounding from evolving COVID-19 variants and prophylaxis protocols across the 2020–2024 period is not fully addressed.
Prioritize targeted venous Doppler ultrasound screening in COVID-19 inpatients with prior DVT history, obesity, active smoking, or supplemental oxygen need — these patients face the highest DVT risk despite routine pharmacological prophylaxis. DVT occurrence signals a high-risk patient likely to need ICU-level care and at serious risk of PE and death.
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