Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis

F A Klok, M J H A Kruip, N J M van der Meer, M S Arbous, D Gommers, K M Kant, F H J Kaptein, J van Paassen, M A M Stals, M V Huisman, H Endeman, F A Klok, M J H A Kruip, N J M van der Meer, M S Arbous, D Gommers, K M Kant, F H J Kaptein, J van Paassen, M A M Stals, M V Huisman, H Endeman

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.

Keywords: COVID-19; Deep vein thrombosis; Pulmonary embolism; Stroke; Venous thromboembolism.

Conflict of interest statement

Declaration of competing interest Frederikus Klok reports research grants from Bayer, Bristol-Myers Squibb, Boehringer-Ingelheim, Daiichi-Sankyo, MSD and Actelion, the Dutch Heart foundation and the Dutch Thrombosis association, all outside the submitted work. Menno Huisman reports grants from ZonMW Dutch Healthcare Fund, and grants and personal fees from Boehringer-Ingelheim, Pfizer-BMS, Bayer Health Care, Aspen, Daiichi-Sankyo, all outside the submitted work. Marieke Kruip reports unrestricted research grants from Bayer, Boehringer-Ingelheim, Daiichi-Sankyo, Pfizer, Sobi, and The Netherlands Organisation for Health Research and Development (ZonMW). The other authors having nothing to disclose.

Copyright © 2020. Published by Elsevier Ltd.

Figures

Fig. 1
Fig. 1
Cumulative incidence of venous and arterial thrombotic complications during the course of intensive care unit admission of patients with proven COVID-19 pneumonia.

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Source: PubMed

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