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Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis.
Klok, F A; Kruip, M J H A; van der Meer, N J M; Arbous, M S; Gommers, D; Kant, K M; Kaptein, F H J; van Paassen, J; Stals, M A M; Huisman, M V; Endeman, H.
  • Klok FA; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: f.a.klok@LUMC.nl.
  • Kruip MJHA; Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands.
  • van der Meer NJM; Department of Anesthesiology and Critical Care, Amphia Hospital Breda, Oosterhout, the Netherlands; TIAS/Tilburg University Tilburg, the Netherlands.
  • Arbous MS; Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands.
  • Gommers D; Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands.
  • Kant KM; Department of Intensive Care, Amphia Hospital, Breda, the Netherlands.
  • Kaptein FHJ; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
  • van Paassen J; Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands.
  • Stals MAM; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
  • Huisman MV; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
  • Endeman H; Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands.
Thromb Res ; 191: 148-150, 2020 07.
Article in English | MEDLINE | ID: covidwho-154635
ABSTRACT

INTRODUCTION:

We recently reported a high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 admitted to the intensive care units (ICUs) of three Dutch hospitals. In answering questions raised regarding our study, we updated our database and repeated all analyses.

METHODS:

We re-evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction and/or systemic arterial embolism in all COVID-19 patients admitted to the ICUs of 2 Dutch university hospitals and 1 Dutch teaching hospital from ICU admission to death, ICU discharge or April 22nd 2020, whichever came first.

RESULTS:

We studied the same 184 ICU patients as reported on previously, of whom a total of 41 died (22%) and 78 were discharged alive (43%). The median follow-up duration increased from 7 to 14 days. All patients received pharmacological thromboprophylaxis. The cumulative incidence of the composite outcome, adjusted for competing risk of death, was 49% (95% confidence interval [CI] 41-57%). The majority of thrombotic events were PE (65/75; 87%). In the competing risk model, chronic anticoagulation therapy at admission was associated with a lower risk of the composite outcome (Hazard Ratio [HR] 0.29, 95%CI 0.091-0.92). Patients diagnosed with thrombotic complications were at higher risk of all-cause death (HR 5.4; 95%CI 2.4-12). Use of therapeutic anticoagulation was not associated with all-cause death (HR 0.79, 95%CI 0.35-1.8).

CONCLUSION:

In this updated analysis, we confirm the very high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 pneumonia.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Arterial Occlusive Diseases / Pulmonary Embolism / Coronavirus Infections / Thrombophilia / Venous Thrombosis Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Thromb Res Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Arterial Occlusive Diseases / Pulmonary Embolism / Coronavirus Infections / Thrombophilia / Venous Thrombosis Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Thromb Res Year: 2020 Document Type: Article