Abstract
Background:Covid-19 associated coagulopathy (CAC) is associated with prothrombotic state and thromboembolism. However, true incidence of thromboembolic events is difficult to determine in the ICU setting. The aim of our study was to investigate the cumulative incidence of thromboembolic events in Covid-19 patients needing intensive care unit (ICU) admission and assessing the utility of point of care ultrasound (POCUS) to screen for and diagnose lower extremity deep venous thrombosis (DVT).Methods:We conducted a prospective observational study between April 22nd and May 26th, 2020 where all adult patients with the diagnosis of Covid-19 pneumonia admitted to 8 ICUs of Montefiore Medical Center were included. POCUS exam was performed on all patients at day 1 of ICU admission and at day 7 and 14 after the first exam.Results:The primary outcome was to study the cumulative incidence of thromboembolic events in Covid-19 patients needing ICU admission. A total of 107 patients were included. All patients got POCUS exam on day 1 in the ICU, 62% got day 7 and 41% got day 14 exam. POCUS diagnosed 17 lower extremity DVTs on day 1, 3 new on day 7 and 1 new on day 14. Forty patients developed 52 thromboembolic events, with the rate of 37.3%. We found a high 45-day cumulative incidence of thromboembolic events of 37% and a high 45-day cumulative incidence of lower and upper extremity DVT of 21% and 10% respectively. Twelve (30%) patients had failure of therapeutic anticoagulation. Occurrence of a thromboembolic event was not associated with a higher risk of mortality (HR 1.08, p value = .81).Conclusions:Covid-19 patients in ICU have a high cumulative incidence of thromboembolic events, but not associated with higher mortality. POCUS is an excellent tool to help screen and diagnose DVT during a pandemic.
Highlights
Coronavirus-19 induced disease (Covid-19) caused by novel SARS- CoV-2 virus, was declared a global pandemic by World Health Organization in March 2020, after the first case was diagnosed in Wuhan, China in December 2019.1 The disease affects lungs primarily, severity ranging from mild or asymptomatic cases to severe ones with acute respiratory distress syndrome (ARDS), septic shock and multi system organ failure.[2]
True positive by point of care ultrasound (POCUS) Official ultrasound did not confirm LE deep venous thrombosis (DVT) diagnosed on POCUS, since there was a Positive delay in the performance of official ultrasound
We found that occurrence of a thromboembolic event was not associated with higher risk of mortality among Covid-19 patients in intensive care unit (ICU) (HR of 1.08, p value 1⁄4 .81)
Summary
Coronavirus-19 induced disease (Covid-19) caused by novel SARS- CoV-2 virus, was declared a global pandemic by World Health Organization in March 2020, after the first case was diagnosed in Wuhan, China in December 2019.1 The disease affects lungs primarily, severity ranging from mild or asymptomatic cases to severe ones with acute respiratory distress syndrome (ARDS), septic shock and multi system organ failure.[2]. The aim of our study was to investigate the cumulative incidence of thromboembolic events in Covid-19 patients needing intensive care unit (ICU) admission and assessing the utility of point of care ultrasound (POCUS) to screen for and diagnose lower extremity deep venous thrombosis (DVT). POCUS exam was performed on all patients at day 1 of ICU admission and at day 7 and 14 after the first exam. Results: The primary outcome was to study the cumulative incidence of thromboembolic events in Covid-19 patients needing ICU admission. POCUS diagnosed 17 lower extremity DVTs on day 1, 3 new on day 7 and 1 new on day 14. Conclusions: Covid-19 patients in ICU have a high cumulative incidence of thromboembolic events, but not associated with higher mortality. POCUS is an excellent tool to help screen and diagnose DVT during a pandemic
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