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Thrombosis and Bleeding After Implementation of an Intermediate-Dose Prophylactic Anticoagulation Protocol in ICU

Kais Al-Abani1, Naima Kilhamn1, Eva Maret2,3

  • 159562Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.

Journal of Intensive Care Medicine
|November 25, 2021
PubMed

Insights

Intermediate-dose anticoagulation in intensive care unit (ICU) patients with COVID-19 showed high rates of venous thromboembolism (VTE) and bleeding. Screening identified VTE in about half of these critically ill patients.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Cardiovascular Thrombosis

Background:

  • Venous thromboembolism (VTE) is a significant concern in critically ill patients with coronavirus disease 2019 (COVID-19).
  • Limited data exists on VTE prevalence and bleeding risks associated with intermediate-dose prophylactic anticoagulation in this population.

Purpose of the Study:

  • To evaluate the incidence of VTE and bleeding complications in intensive care unit (ICU) patients with COVID-19.
  • To assess the effectiveness of an intermediate-dose prophylactic anticoagulation protocol in preventing VTE.

Main Methods:

  • Prospective, observational study conducted in 6 ICUs across 2 Swedish university-affiliated hospitals.
  • Included 100 COVID-19 patients treated with intermediate-dose prophylactic anticoagulation.
  • Utilized ultrasound screening for deep vein thrombosis (DVT) and analyzed computed tomography pulmonary angiography results.

Main Results:

  • VTE was detected in 37% of patients during a median follow-up of 120 days, with most diagnosed post-ICU admission.
  • Proximal lower-extremity DVT occurred in 20 patients (95% detected by ultrasound); pulmonary vascular thrombosis in 22 patients.
  • Major bleeding in 10 patients and non-major bleeding in 18 patients were observed. Pre-existing heart failure was the only significant baseline predictor of VTE.

Conclusions:

  • A high prevalence of VTE and bleeding complications was observed in ICU patients with COVID-19 on intermediate-dose anticoagulation.
  • Screening ultrasound identified VTE in approximately half of the studied patients, highlighting the need for vigilant monitoring.

Keywords:
COVID-19anticoagulationhemorrhageultrasonographyvenous thromboembolism

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