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Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study

Akshay Shah1,2, Killian Donovan3, Anna McHugh4

  • 1Radcliffe Department of Medicine, Level 4 Academic Block, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK. akshay.shah@linacre.ox.ac.uk.

Critical Care (London, England)
|September 19, 2020
PubMed

Insights

Critically ill patients with COVID-19 have high rates of thrombotic complications, including pulmonary emboli and arterial events. Bleeding complications also occurred, highlighting the need for further research into optimal anticoagulation strategies for COVID-19 patients.

Area of Science:

  • Critical care medicine
  • Hematology
  • Infectious diseases

Background:

  • Thromboembolic disease management in COVID-19 patients is challenging.
  • Understanding thrombotic and bleeding risks is crucial for critically ill patients.

Purpose of the Study:

  • Define the incidence of thrombotic and hemorrhagic complications in critically ill COVID-19 patients.
  • Characterize coagulation profiles using thromboelastography.
  • Identify biological differences between patients with and without thrombotic complications.

Main Methods:

  • Multicenter retrospective observational study of 187 COVID-19 patients in UK intensive care units (ICUs).
  • Evaluation of clinical characteristics, laboratory data, thromboelastography, and outcomes.
  • Comparison between patients with and without thrombotic complications.

Main Results:

  • 43.3% of patients experienced thrombotic complications (22.5% pulmonary emboli, 13.3% arterial).
  • Higher D-dimer, ferritin, troponin, and white cell counts were observed in patients with thrombotic complications.
  • Thromboelastography showed hypercoagulability but lacked discriminatory value.

Conclusions:

  • Critically ill COVID-19 patients face significant risks of venous and arterial thrombotic events.
  • Bleeding complication rates may be higher than previously reported.
  • Randomized trials are needed to optimize anticoagulation strategies.
Abstract

Keywords:
COVID-19HaemorrhageHeparinThrombosis

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