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Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis.
Thromb Res. 2020 07; 191:148-150.TR

Abstract

INTRODUCTION

We recently reported a high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 admitted to the intensive care units (ICUs) of three Dutch hospitals. In answering questions raised regarding our study, we updated our database and repeated all analyses.

METHODS

We re-evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction and/or systemic arterial embolism in all COVID-19 patients admitted to the ICUs of 2 Dutch university hospitals and 1 Dutch teaching hospital from ICU admission to death, ICU discharge or April 22nd 2020, whichever came first.

RESULTS

We studied the same 184 ICU patients as reported on previously, of whom a total of 41 died (22%) and 78 were discharged alive (43%). The median follow-up duration increased from 7 to 14 days. All patients received pharmacological thromboprophylaxis. The cumulative incidence of the composite outcome, adjusted for competing risk of death, was 49% (95% confidence interval [CI] 41-57%). The majority of thrombotic events were PE (65/75; 87%). In the competing risk model, chronic anticoagulation therapy at admission was associated with a lower risk of the composite outcome (Hazard Ratio [HR] 0.29, 95%CI 0.091-0.92). Patients diagnosed with thrombotic complications were at higher risk of all-cause death (HR 5.4; 95%CI 2.4-12). Use of therapeutic anticoagulation was not associated with all-cause death (HR 0.79, 95%CI 0.35-1.8).

CONCLUSION

In this updated analysis, we confirm the very high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 pneumonia.

Authors+Show Affiliations

Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: f.a.klok@LUMC.nl.Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands.Department of Anesthesiology and Critical Care, Amphia Hospital Breda, Oosterhout, the Netherlands; 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

32381264

Citation

Klok, F A., et al. "Confirmation of the High Cumulative Incidence of Thrombotic Complications in Critically Ill ICU Patients With COVID-19: an Updated Analysis." Thrombosis Research, vol. 191, 2020, pp. 148-150.
Klok FA, Kruip MJHA, van der Meer NJM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thromb Res. 2020;191:148-150.
Klok, F. A., Kruip, M. J. H. A., van der Meer, N. J. M., Arbous, M. S., Gommers, D., Kant, K. M., Kaptein, F. H. J., van Paassen, J., Stals, M. A. M., Huisman, M. V., & Endeman, H. (2020). Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thrombosis Research, 191, 148-150. https://doi.org/10.1016/j.thromres.2020.04.041
Klok FA, et al. Confirmation of the High Cumulative Incidence of Thrombotic Complications in Critically Ill ICU Patients With COVID-19: an Updated Analysis. Thromb Res. 2020;191:148-150. PubMed PMID: 32381264.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. AU - Klok,F A, AU - Kruip,M J H A, AU - van der Meer,N J M, AU - Arbous,M S, AU - Gommers,D, 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 - 2020/04/30/ PY - 2020/5/10/pubmed PY - 2020/6/13/medline PY - 2020/5/9/entrez KW - COVID-19 KW - Deep vein thrombosis KW - Pulmonary embolism KW - Stroke KW - Venous thromboembolism SP - 148 EP - 150 JF - Thrombosis research JO - Thromb Res VL - 191 N2 - INTRODUCTION: We recently reported a high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 admitted to the intensive care units (ICUs) of three Dutch hospitals. In answering questions raised regarding our study, we updated our database and repeated all analyses. METHODS: We re-evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction and/or systemic arterial embolism in all COVID-19 patients admitted to the ICUs of 2 Dutch university hospitals and 1 Dutch teaching hospital from ICU admission to death, ICU discharge or April 22nd 2020, whichever came first. RESULTS: We studied the same 184 ICU patients as reported on previously, of whom a total of 41 died (22%) and 78 were discharged alive (43%). The median follow-up duration increased from 7 to 14 days. All patients received pharmacological thromboprophylaxis. The cumulative incidence of the composite outcome, adjusted for competing risk of death, was 49% (95% confidence interval [CI] 41-57%). The majority of thrombotic events were PE (65/75; 87%). In the competing risk model, chronic anticoagulation therapy at admission was associated with a lower risk of the composite outcome (Hazard Ratio [HR] 0.29, 95%CI 0.091-0.92). Patients diagnosed with thrombotic complications were at higher risk of all-cause death (HR 5.4; 95%CI 2.4-12). Use of therapeutic anticoagulation was not associated with all-cause death (HR 0.79, 95%CI 0.35-1.8). CONCLUSION: In this updated analysis, we confirm the very high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 pneumonia. SN - 1879-2472 UR - https://www.unboundmedicine.com/medline/citation/32381264/Confirmation_of_the_high_cumulative_incidence_of_thrombotic_complications_in_critically_ill_ICU_patients_with_COVID_19:_An_updated_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-3848(20)30157-2 DB - PRIME DP - Unbound Medicine ER -