COVID-19: High Incidence of Thromboembolic Complications in ICU Patients

Pavankumar Kamat

September 25, 2020

According to a new study published in  Critical Care,  critically ill patients with COVID-19 have high rates of thromboembolic complications. Additionally, the incidence of bleeding may be higher than previously reported in such patients.

The data come from a multicentre, retrospective observational study involving 187 adult patients with COVID-19 admitted to intensive care units (ICUs) of four tertiary hospitals in the UK.

43.3 per cent of patients experienced one or more clinically relevant thrombotic complication, primarily pulmonary embolism (22.5%). 13.3 per cent of patients reported arterial embolic complications. Patients with thrombotic complications had a longer length of stay in the ICU compared with those without complications (17 vs 12 days; P=.003). 8 per cent of patients had haemorrhagic complications, of which 4.8 per cent were cases of major bleeding.

Patients with thrombotic complications had significantly higher values of D-dimer (P<.001), troponin T (P=.008), troponin I (P<.001), white blood cell count (P=.024) and ferritin (P=.008) at admission compared with those without complications. Thromboelastography was performed in 20 patients, but it lacked discriminatory value.

"Our multicentre study supports previous reports of a high incidence of thromboembolic complications in ICU patients with COVID-19, despite the initiation of thromboprophylaxis," the authors say. They call for further randomised trials to understand the risk-benefit ratio of anticoagulation strategies in detail.

Shah A, Donovan K, McHugh A, Pandey M, Aaron L, Bradbury CA, Stanworth SJ, Alikhan R, Von Kier S, Maher K, Curry N, Shapiro S, Rowland MJ, Thomas M, Mason R, Holland M, Holmes T, Ware M, Gurney S, McKechnie SR. Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study. Crit Care. 2020;24(1):561. doi: 10.1186/s13054-020-03260-3. PMID: 32948243 View full text

This article originally appeared on Univadis, part of the Medscape Professional Network.

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