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Incidence of thrombotic complications in critically ill ICU patients with COVID-19.
Thromb Res. 2020 07; 191:145-147.TR

Abstract

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.

Authors+Show Affiliations

Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: f.a.klok@LUMC.nl.Department of Haematology, Erasmus University Medical Center, Rotterdam, the Netherlands.Department of Anesthesiology and Critical Care, Amphia Hospital Breda and Oosterhout the Netherlands and TIAS/Tilburg University, Tilburg, the Netherlands.Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands.Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands.Department of Intensive Care, Amphia Hospital, Breda, the Netherlands.Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands.Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32291094

Citation

Klok, F A., et al. "Incidence of Thrombotic Complications in Critically Ill ICU Patients With COVID-19." Thrombosis Research, vol. 191, 2020, pp. 145-147.
Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145-147.
Klok, F. A., Kruip, M. J. H. A., van der Meer, N. J. M., Arbous, M. S., Gommers, D. A. M. P. J., Kant, K. M., Kaptein, F. H. J., van Paassen, J., Stals, M. A. M., Huisman, M. V., & Endeman, H. (2020). Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis Research, 191, 145-147. https://doi.org/10.1016/j.thromres.2020.04.013
Klok FA, et al. Incidence of Thrombotic Complications in Critically Ill ICU Patients With COVID-19. Thromb Res. 2020;191:145-147. PubMed PMID: 32291094.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence of thrombotic complications in critically ill ICU patients with COVID-19. AU - Klok,F A, AU - Kruip,M J H A, AU - van der Meer,N J M, AU - Arbous,M S, AU - Gommers,D A M P J, AU - Kant,K M, AU - Kaptein,F H J, AU - van Paassen,J, AU - Stals,M A M, AU - Huisman,M V, AU - Endeman,H, Y1 - 2020/04/10/ PY - 2020/4/16/pubmed PY - 2020/6/13/medline PY - 2020/4/16/entrez KW - COVID-19 KW - Deep vein thrombosis KW - Pulmonary embolism KW - Stroke KW - Thromboprophylaxis SP - 145 EP - 147 JF - Thrombosis research JO - Thromb Res VL - 191 N2 - 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. SN - 1879-2472 UR - https://www.unboundmedicine.com/medline/citation/32291094/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-3848(20)30120-1 DB - PRIME DP - Unbound Medicine ER -