Incidence of thrombotic complications in critically ill ICU patients with COVID-19

By F. Klok, M. Kruip, N. Meer, M. Arbous, D. Gommers, K. Kant, F. Kaptein, J. Paassen, M. Stals, M. Huisman and 1 more. Thrombosis Research, 2020

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Introduction COVID-19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation. Reports on the incidence of thrombotic complications are however not available. Methods We evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction or systemic arterial embolism in all COVID-19 patients admitted to the ICU of 2 Dutch university hospitals and 1 Dutch teaching hospital. Results We studied 184 ICU patients with proven COVID-19 pneumonia of whom 23 died (13%), 22 were discharged alive (12%) and 139 (76%) were still on the ICU on April 5th 2020. All patients received at least standard doses thromboprophylaxis. The cumulative incidence of the composite outcome was 31% (95%CI 20-41), of which CTPA and/or ultrasonography confirmed VTE in 27% (95%CI 17-37%) and arterial thrombotic events in 3.7% (95%CI 0-8.2%). PE was the most frequent thrombotic complication (n = 25, 81%). Age (adjusted hazard ratio (aHR) 1.05/per year, 95%CI 1.004-1.01) and coagulopathy, defined as spontaneous prolongation of the prothrombin time > 3 s or activated partial thromboplastin time > 5 s (aHR 4.1, 95%CI 1.9-9.1), were independent predictors of thrombotic complications. Conclusion The 31% incidence of thrombotic complications in ICU patients with COVID-19 infections is remarkably high. Our findings reinforce the recommendation to strictly apply pharmacological thrombosis prophylaxis in all COVID-19 patients admitted to the ICU, and are strongly suggestive of increasing the prophylaxis towards high-prophylactic doses, even in the absence of randomized evidence.

Subfields: Infectious Diseases, Oncology, Surgery

View Paper: https://www.semanticscholar.org/paper/a20608b31dce92277378fc9b78aff5f0af478bdb

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Citations in the corpus

High incidence of venous thromboembolic events in anticoagulated severe COVID‐19 patients (2020, neutral): “5 (74-116) 106 (82-115) 78 (70-117) Mechanical ventilation 26 (100) 8 (100) 18 (100) Prone positioning 16 (62) 5 (62) 11 (61) Venovenous extracorporeal membrane oxygenation 2 (8) 1 (12) 1 (5)”
COVID-19 and the human innate immune system (2021, background): “These findings go hand in hand with the thrombotic complications and coagulopathy frequently found in severe COVID-19 (Klok et al., 2020), because NET formation can seed immunothrombosis (Veras et al.”
Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US. (2020, background): “Length of mechanical ventilatory support, median (IQR), d 11 (7-14) 13 (9-14) 9 (5-13)”
Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy (2020, positive): “In a recent Dutch paper, symptomatic VTE was diagnosed in 28 (15% of total; cumulative rate 27%) of 184 patients receiving thromboprophylaxis during intensive care and mainly consisted of PE (n = 25) [10].”
SARS-CoV-2 binds platelet ACE2 to enhance thrombosis in COVID-19 (2020, background): “3% of non-COVID-19 ICU patients experience thrombotic complications [9].”
Coagulation abnormalities and thrombosis in patients with COVID-19 (2020, background): “10 Some people have also suggested that pulmonary embolism could be involved in the rapid respiratory deterioration seen in some patients, 10 but for practical reasons, doing adequate objective diagnostic testing is not always possible (eg, CT-angiography).”