Hemodynamic and Clinical Predictors of Thrombolysis in Post-COVID Venous Thromboembolism: A Retrospective Cohort Study

Cojocaru, Giulia-Mihaela; Petriş, Antoniu Octavian; Pînzariu, Alin-Constantin; Cojocaru, Tudor; Coca, Andreea; Cojocaru, Ruxandra; Costan, Catherine-Teodora; Șorodoc, Victorița; Cojocaru, Elena

doi:10.3390/biomedicines13092232

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Hemodynamic and Clinical Predictors of Thrombolysis in Post-COVID Venous Thromboembolism: A Retrospective Cohort Study

by

Giulia-Mihaela Cojocaru

¹,

Antoniu Octavian Petriş

^2,3,†

,

Alin-Constantin Pînzariu

^4,*

,

Tudor Cojocaru

^5,†

,

Andreea Coca

⁶,

Ruxandra Cojocaru

^5,†,

Catherine-Teodora Costan

⁵,

Victorița Șorodoc

^7,8

and

Elena Cojocaru

^4,†

¹

Faculty of Medicine, Doctoral School of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania

²

Medical I Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania

³

Cardiology Clinic, “Sf. Spiridon” Clinical County Emergency Hospital, 700111 Iaşi, Romania

⁴

Morpho-Functional Sciences II Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine, and Pharmacy, 700115 Iasi, Romania

⁵

Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania

⁶

Department of Rheumatology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA

⁷

Internal Medicine and Toxicology Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania

⁸

Medical III Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

Biomedicines 2025, 13(9), 2232; https://doi.org/10.3390/biomedicines13092232 (registering DOI)

Submission received: 5 August 2025 / Revised: 3 September 2025 / Accepted: 8 September 2025 / Published: 10 September 2025

(This article belongs to the Special Issue Cardiac and Vascular Diseases: Pathogenesis, Pharmacological Treatments, Advances in Therapies (3rd Edition))

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Abstract

Objectives: Post-acute venous thromboembolism (VTE) is a well-recognized complication of COVID-19, driven by persistent endothelial dysfunction and thromboinflammation. Identifying simple clinical predictors of VTE may optimize therapy and limit adverse outcomes. We propose a pragmatic risk-stratification approach, based on clinical and echocardiographic parameters. Methods: We conducted a retrospective cohort study in a Romanian tertiary hospital (March 2020–April 2022) in 54 adults with laboratory-confirmed COVID-19 and imaging-confirmed VTE. Demographics, comorbidities, laboratory markers, and echocardiographic variables—particularly tricuspid annular plane systolic excursion (TAPSE), peripheral oxygen saturation (SpO₂), and left-ventricular end-diastolic diameter (LVEDD)—were collected. The primary outcome was the percentage of patients receiving systemic thrombolysis. Statistical analyses included Mann–Whitney U tests, chi-square, Spearman correlations, and multivariable logistic regression. Results: The mean age was 61.2 ± 14.7 years, and 63% were men. Eleven patients (20.4%) underwent thrombolysis. Compared with conservatively managed patients, those receiving thrombolysis had lower TAPSE (13.0 vs. 20.8 mm), lower SpO₂ (90.1 vs. 97.0%), and smaller LVEDD (24.4 vs. 46.1 mm); all differences were statistically significant. Each 1 mm decrease in TAPSE and 1% decrease in SpO₂ increased the likelihood of thrombolysis (adjusted odds ratios 1.58 and 1.34, respectively). Inflammatory markers and right-ventricular diameter were not associated with treatment. Conclusions: Reduced TAPSE, lower SpO₂, and decreased LVEDD identify post-COVID VTE patients at elevated risk of hemodynamic compromise requiring thrombolysis. A point-of-care assessment incorporating these variables may improve early risk stratification and guide therapeutic decisions.

Keywords: COVID-19; echocardiography; post-COVID syndrome; pulmonary embolism; SpO₂; TAPSE; thrombolysis; VTE

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MDPI and ACS Style

Cojocaru, G.-M.; Petriş, A.O.; Pînzariu, A.-C.; Cojocaru, T.; Coca, A.; Cojocaru, R.; Costan, C.-T.; Șorodoc, V.; Cojocaru, E. Hemodynamic and Clinical Predictors of Thrombolysis in Post-COVID Venous Thromboembolism: A Retrospective Cohort Study. Biomedicines 2025, 13, 2232. https://doi.org/10.3390/biomedicines13092232

AMA Style

Cojocaru G-M, Petriş AO, Pînzariu A-C, Cojocaru T, Coca A, Cojocaru R, Costan C-T, Șorodoc V, Cojocaru E. Hemodynamic and Clinical Predictors of Thrombolysis in Post-COVID Venous Thromboembolism: A Retrospective Cohort Study. Biomedicines. 2025; 13(9):2232. https://doi.org/10.3390/biomedicines13092232

Chicago/Turabian Style

Cojocaru, Giulia-Mihaela, Antoniu Octavian Petriş, Alin-Constantin Pînzariu, Tudor Cojocaru, Andreea Coca, Ruxandra Cojocaru, Catherine-Teodora Costan, Victorița Șorodoc, and Elena Cojocaru. 2025. "Hemodynamic and Clinical Predictors of Thrombolysis in Post-COVID Venous Thromboembolism: A Retrospective Cohort Study" Biomedicines 13, no. 9: 2232. https://doi.org/10.3390/biomedicines13092232

APA Style

Cojocaru, G.-M., Petriş, A. O., Pînzariu, A.-C., Cojocaru, T., Coca, A., Cojocaru, R., Costan, C.-T., Șorodoc, V., & Cojocaru, E. (2025). Hemodynamic and Clinical Predictors of Thrombolysis in Post-COVID Venous Thromboembolism: A Retrospective Cohort Study. Biomedicines, 13(9), 2232. https://doi.org/10.3390/biomedicines13092232

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Hemodynamic and Clinical Predictors of Thrombolysis in Post-COVID Venous Thromboembolism: A Retrospective Cohort Study

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