Abstract
Aims of the study: Virchow’s triad with stasis, activated coagulation, and endothelial damage is common in SARS-CoV2. Therefore, we sought to retrospectively assess whether the duration of prone position may serve as a risk factor for deep vein thrombosis in critically ill patients. Methods: In this single center retrospective study of a tertiary referral hospital, patients with acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia admitted to critical care underwent venous ultrasound screening for deep vein thrombosis (DVT). Data on DVT diagnosis, duration of prone positioning, demographic, respiratory, and laboratory parameters were retrospectively collected and compared between DVT and non-DVT patients. Results: 21 patients with ARDS from COVID-19 pneumonia were analyzed. DVT was detected in 11 (52%) patients (76.2% male, median age 64 (58; 68.5) years, median body mass index 31 (27; 33.8) kg/m2). In patients diagnosed with DVT, median prone ventilation had been maintained twice as long as compared to patients without DVT (57 (19; 72) versus 28 (0; 56.3) h, p = 0.227) on ICU day 5 with a trend towards longer prone position time (71 (19; 104) versus 28 (0; 73) h, p = 0.06) on ICU day 7. Conclusions: Prone ventilation and constitutional factors may constitute an additional risk factor for DVT in COVID-19 patients. Since recent studies have shown that therapeutic anticoagulation does not impact the occurrence of thromboembolic events, it may be worthwhile to consider mechanical factors potentially affecting blood flow stasis in this high-risk population. However, due to the limited number of patients, our observations should only be considered as hypothesis-generating. Future studies, sufficiently powered and preferably prospective, will be needed to confirm our hypothesis.
Highlights
Coronavirus disease-2019 (COVID-19) is associated with a high burden of venous thromboembolic events (VTE) in critically ill patients [1]
Following the urgent call for close ultrasound screening for the early detection of Deep vein thrombosis (DVT) [7], we aimed to evaluate whether the application and duration of prone position may serve as an additional risk factor for DVT in critically ill patients with SARSCoV2 admitted to the intensive care unit (ICU) and to raise a new aspect of DVT genesis in acute respiratory distress syndrome (ARDS) patients
In median prone position (PP) time, a trend towards a higher prone time in patients with DVT compared to non-DVT patients upon ICU day 7 (71 (19; 104) h versus 28 (0; 73) h, p = 0.006) was observed, while we found no differences in PP time summarized up to day 5 in DVT
Summary
Coronavirus disease-2019 (COVID-19) is associated with a high burden of venous thromboembolic events (VTE) in critically ill patients [1]. Hypoxia, constitutional factors, hyperviscosity, and blood-flow and stasis may further promote the occurrence of VTE [3]. In COVID-19 acute respiratory distress syndrome (ARDS), prone position (PP) was frequently applied. While several studies have addressed the higher risk of DVT in critically ill patients, PP as a potential contributor to blood-flow changes has not been considered as a risk factor in these trials [4–6]. Following the urgent call for close ultrasound screening for the early detection of DVT [7], we aimed to evaluate whether the application and duration of prone position may serve as an additional risk factor for DVT in critically ill patients with SARSCoV2 admitted to the intensive care unit (ICU) and to raise a new aspect of DVT genesis in ARDS patients
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