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.; Meer, N.J.M. van der; Arbous, M.S.; Gommers, D.; Kant, K.M.; ... ; Endeman, H. (2020)

Article / Letter to editor

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.

• Venous thromboembolism
• Pulmonary embolism
• Deep vein thrombosis
• COVID-19
• Stroke

• All authors: Klok, F.A.; Kruip, M.J.H.A.; Meer, N.J.M. van der; Arbous, M.S.; Gommers, D.; Kant, K.M.; Kaptein, F.H.J.; Paassen, J. van; Stals, M.A.M.; Huisman, M.V.; Endeman, H.
• Date: 2020-07-01
• Journal: Thrombosis Research: Vascular Obstruction, Hemorrhage and Hemostasis
• Volume: 191
• Pages: 148 - 150
• DOI: doi:10.1016/j.thromres.2020.04.041
• Link: https://www.sciencedirect.com/science/article/pii/S0049384820301572?via%...