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Prevalence of Thrombotic Complications in ICU-Treated Patients With Coronavirus Disease 2019 Detected With Systematic CT Scanning.
Mirsadraee, Saeed; Gorog, Diana A; Mahon, Ciara F; Rawal, Bhavin; Semple, Thomas R; Nicol, Edward D; Arachchillage, Deepa R J; Devaraj, Anand; Price, Susanna; Desai, Sujal R; Ridge, Carole A; Singh, Suveer; Padley, Simon P G.
  • Mirsadraee S; Royal Brompton Hospital, London, United Kingdom.
  • Gorog DA; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
  • Mahon CF; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
  • Rawal B; Lister Hospital, Coreys Mill Lane, Stevenage, United Kingdom.
  • Semple TR; Royal Brompton Hospital, London, United Kingdom.
  • Nicol ED; Royal Brompton Hospital, London, United Kingdom.
  • Arachchillage DRJ; Royal Brompton Hospital, London, United Kingdom.
  • Devaraj A; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
  • Price S; Royal Brompton Hospital, London, United Kingdom.
  • Desai SR; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
  • Ridge CA; Centre for Haematology, Imperial College London, London, United Kingdom.
  • Singh S; Royal Brompton Hospital, London, United Kingdom.
  • Padley SPG; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Crit Care Med ; 49(5): 804-815, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1075628
ABSTRACT

OBJECTIVES:

Severe coronavirus disease 2019 is associated with an extensive pneumonitis and frequent coagulopathy. We sought the true prevalence of thrombotic complications in critically ill patients with severe coronavirus disease 2019 on the ICU, with or without extracorporeal membrane oxygenation.

DESIGN:

We undertook a single-center, retrospective analysis of 72 critically ill patients with coronavirus disease 2019-associated acute respiratory distress syndrome admitted to ICU. CT angiography of the thorax, abdomen, and pelvis were performed at admission as per routine institution protocols, with further imaging as clinically indicated. The prevalence of thrombotic complications and the relationship with coagulation parameters, other biomarkers, and survival were evaluated.

SETTING:

Coronavirus disease 2019 ICUs at a specialist cardiorespiratory center. PATIENTS Seventy-two consecutive patients with coronavirus disease 2019 admitted to ICU during the study period (March 19, 2020, to June 23, 2020).

INTERVENTIONS:

None. MEASUREMENTS AND MAIN

RESULTS:

All but one patient received thromboprophylaxis or therapeutic anticoagulation. Among 72 patients (malefemale = 74%; mean age 52 ± 10; 35 on extracorporeal membrane oxygenation), there were 54 thrombotic complications in 42 patients (58%), comprising 34 pulmonary arterial (47%), 15 peripheral venous (21%), and five (7%) systemic arterial thromboses/end-organ embolic complications. In those with pulmonary arterial thromboses, 93% were identified incidentally on first screening CT with only 7% suspected clinically. Biomarkers of coagulation (e.g., d-dimer, fibrinogen level, and activated partial thromboplastin time) or inflammation (WBC count, C-reactive protein) did not discriminate between patients with or without thrombotic complications. Fifty-one patients (76%) survived to discharge; 17 (24%) patients died. Mortality was significantly greater in patients with detectable thrombus (33% vs 10%; p = 0.022).

CONCLUSIONS:

There is a high prevalence of thrombotic complications, mainly pulmonary, among coronavirus disease 2019 patients admitted to ICU, despite anticoagulation. Detection of thrombus was usually incidental, not predicted by coagulation or inflammatory biomarkers, and associated with increased risk of death. Systematic CT imaging at admission should be considered in all coronavirus disease 2019 patients requiring ICU.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombosis / Critical Illness / Computed Tomography Angiography / COVID-19 Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Systematic review/Meta Analysis Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Crit Care Med Year: 2021 Document Type: Article Affiliation country: CCM.0000000000004890

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Thrombosis / Critical Illness / Computed Tomography Angiography / COVID-19 Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Systematic review/Meta Analysis Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Crit Care Med Year: 2021 Document Type: Article Affiliation country: CCM.0000000000004890