Abstract
IntroductionCOVID-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. MethodsWe 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. ResultsWe 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. ConclusionThe 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.
Highlights
COVID-19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation
We evaluated the incidence of the composite outcome of venous thromboembolism (VTE) and arterial thrombotic complications in all COVID-19 patients admitted to the intensive care unit (ICU) of 2 Dutch university hospitals and 1 Dutch teaching hospital
We studied 184 patients with proven COVID-19 pneumonia (Table 1) admitted to the ICU between March 7th and April 5th 2020
Summary
F.A. Kloka,⁎, M.J.H.A. Kruipb, N.J.M. van der Meerc, M.S. Arbousd, D.A.M.P.J. Gommerse, K.M. Kantf, F.H.J. Kapteina, J. van Paassend, M.A.M. Stalsa, M.V. Huismana,1, H. Endemane,1 a Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands b Department of Haematology, Erasmus University Medical Center, Rotterdam, the Netherlands c Department of Anesthesiology and Critical Care, Amphia Hospital Breda and Oosterhout the Netherlands and TIAS/Tilburg University, Tilburg, the Netherlands d Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands e Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands f Department of Intensive Care, Amphia Hospital, Breda, the Netherlands
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