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Prevalence of Thrombotic Complications in ICU-Treated Patients With Coronavirus Disease 2019 Detected With Systematic
Saeed Mirsadraee1,2, Diana A Gorog2,3, Ciara F Mahon1
1Royal Brompton Hospital, London, United Kingdom.
Insights
Critically ill COVID-19 patients frequently experience thrombotic complications, particularly pulmonary emboli, even with anticoagulation. These clots are often incidentally found on CT scans and linked to higher mortality, suggesting routine imaging is crucial.
Area of Science:
- Critical care medicine
- Cardiovascular medicine
- Pulmonology
Background:
- Severe coronavirus disease 2019 (COVID-19) is linked to significant lung inflammation and coagulopathy.
- Thrombotic complications are a concern in critically ill COVID-19 patients, especially those requiring extracorporeal membrane oxygenation (ECMO).
Purpose of the Study:
- To determine the prevalence of thrombotic complications in critically ill COVID-19 patients within an intensive care unit (ICU).
- To investigate the relationship between thrombotic complications, coagulation parameters, inflammatory biomarkers, and patient survival.
Main Methods:
- A single-center, retrospective analysis of 72 critically ill COVID-19 patients with acute respiratory distress syndrome admitted to the ICU.
- Thoracic, abdominal, and pelvic CT angiography was performed at admission and as clinically indicated.
- Evaluation of thrombotic complication prevalence, coagulation markers, inflammatory biomarkers, and survival rates.
Main Results:
- 58% of patients (42 out of 72) experienced thrombotic complications, most commonly pulmonary arterial thrombosis (47%).
- Pulmonary emboli were often detected incidentally on initial CT scans (93%) and not predicted by coagulation or inflammatory markers.
- Mortality was significantly higher in patients with detectable thrombus (33%) compared to those without (10%).
Conclusions:
- Critically ill COVID-19 patients exhibit a high incidence of thrombotic complications, predominantly pulmonary, despite anticoagulation therapy.
- Thrombus detection was often incidental and not correlated with standard biomarkers, highlighting limitations in current predictive methods.
- Routine CT imaging upon ICU admission for COVID-19 patients is recommended to identify thrombotic events and improve outcomes.
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 (male:female = 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.
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