Thrombotic complications in 2928 patients with COVID-19 treated in intensive care: a systematic review

Jenner, William; Kanji, Rahim; Mirsadraee, Saeed; Gue, Ying X; Price, Susanna; Prasad, Sanjay; Gorog, Diana A.

doi:10.1007/s11239-021-02394-7

Cited by 81 publications

(94 citation statements)

References 59 publications

(76 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There was a statistically significant higher incidence of severe thrombocytopenia, and a tendency towards higher rates of bleeding in the intermediate dose arm; complications that may limit the role of anticoagulation in reducing the thrombotic burden. One observation from this trial was that the incidence of venous thrombosis in the control arm, at 3.5%, was substantially lower that identified in the previously described meta-analysis, and requires further assessment in prospective studies [24].…”

Section: Discussionmentioning

confidence: 62%

“…This compares to an overall incidence of thrombosis of 11.5% in 2505 non-ICU hospitalised patients, comprising PE (2.2%), DVT (2.0%), stroke (0.9%) and myocardial infarction (7.3%). In a meta-analysis of 2928 patients on ICU with COVID-19, our team identified a cumulative thrombotic incidence of 34% [24].…”

Section: Thrombotic Complications Of Covid-19 On the Intensive Care Settingmentioning

confidence: 99%

See 1 more Smart Citation

Incidence of thrombotic complications in COVID-19

Jenner

Gorog

2021

J Thromb Thrombolysis

Self Cite

View full text Add to dashboard Cite

A high incidence of thrombosis in hospitalised patients with COVID-19 was identified early during the pandemic. Accurately quantifying thrombotic risk may assist prognosis and guide appropriate thromboprophylaxis. Observational studies have estimated the rate of thrombosis in both hospitalised and non-hospitalised patients with COVID-19, and how this corresponds to the severity of illness. In this review, we provide an overview of the incidence and prevalence of arterial and venous thrombotic events in patients with COVID-19 and highlight the limitations in the studies to date. Asymptomatic individuals with COVID-19 and those with mild symptoms are at very low risk of thrombotic complications. However, rates of thrombosis are substantially increased in hospitalised patients, and are strikingly high in those patients who are critically-ill requiring treatment on the intensive care unit and especially those requiring extracorporeal membrane oxygenation. Clinicians managing such patients need to be aware of these risks and take appropriate steps with respect to thromboprophylaxis and heightened clinical vigilance. Large prospective observational studies will more accurately quantify thrombotic rate, and randomized controlled trials are currently investigating optimal thromboprophylactic strategies.

show abstract

Section: Discussionmentioning

confidence: 62%

Section: Thrombotic Complications Of Covid-19 On the Intensive Care Settingmentioning

confidence: 99%

Incidence of thrombotic complications in COVID-19

Jenner

Gorog

2021

J Thromb Thrombolysis

Self Cite

View full text Add to dashboard Cite

show abstract

“…Remarkably, Grandmaison et al report a high VTE-incidence of 56% even in ICU patients receiving therapeutic anticoagulation [12]. A recent systematic review of 28 studies including a total of 2,928 patients with COVID-19 found that thrombotic complications were reported in 34% of ICU-managed patients, with DVT in 16.1% and PE in 12.6% of patients, despite anticoagulant thromboprophylaxis [17]. Studies adopting systematic screening for VTE with Duplex ultrasound reported a significantly higher incidence of venous thrombosis on the ICU compared to those relying on clinical suspicion (56.3% vs. 11.0%, p < 0.001) [17].…”

Section: On the Intensive Care Unit (Icu)mentioning

confidence: 99%

Screening for venous thromboembolism in patients with COVID-19

Vandenbriele

Gorog

2021

J Thromb Thrombolysis

Self Cite

View full text Add to dashboard Cite

Pulmonary thromboembolism and deep venous thrombosis occur frequently in hospitalised patients with COVID-19, the prevalence increases on the intensive care unit (ICU) and is very high in patients on extracorporeal membrane oxygenation (ECMO). We undertook a literature review to assess the usefulness of screening for peripheral venous thrombosis or pulmonary thrombosis in patients admitted with COVID-19. Outside of the ICU setting, D-dimer elevation on presentation or marked increase from baseline should alert the need for doppler ultrasound scan of the lower limbs. In the ICU setting, consideration should be given to routine screening with doppler ultrasound, given the high prevalence of thrombosis in this cohort despite standard anticoagulant thromboprophylaxis. However, absence of lower limb thrombosis on ultrasound does not exclude pulmonary venous thrombosis. Screening with CT pulmonary angiography (CTPA) is not justified in patients on the general wards, unless there are clinical features and/or marked elevations in markers of COVID-19-associated coagulopathy. However, the risk of pulmonary embolism or pulmonary thrombosis in ICU patients is very high, especially in patients on ECMO, where studies that employed routine screening for thrombosis with CT scanning have uncovered up to 100% incidence of pulmonary thrombosis despite standard anticoagulant thromboprophylaxis. Therefore, in patients at low bleeding risk and high clinical suspicion of venous thromboembolism, therapeutic anticoagulation should be considered even before screening, Our review highlights the need for increased vigilance for VTE, with a low threshold for doppler ultrasound and CTPA in high risk in-patient cohorts, where clinical features and D-dimer levels may not accurately reflect the occurrence of pulmonary thromboembolism.

show abstract

“…In the only reported case of SVT occurring during ICU stay, the presence of pharmacological prophylaxis of thrombosis was not reported. Previous research suggested that the incidence of thrombotic complications in ICU patients with COVID-19 infections is remarkably high despite anticoagulant therapy at standard prophylactic dose [49] . Notwithstanding this, recent evidence on patients admitted to the ICU with COVID-19 showed that intermediate-dose prophylactic anticoagulation did not result in a significant difference in the primary outcome of a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days [50] .…”

Section: Discussionmentioning

confidence: 99%

Acute splanchnic vein thrombosis in patients with COVID-19: A systematic review

Buso¹,

Becchetti²,

Berzigotti³

2021

Digestive and Liver Disease

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

Thrombotic complications in 2928 patients with COVID-19 treated in intensive care: a systematic review

Cited by 81 publications

References 59 publications

Incidence of thrombotic complications in COVID-19

Incidence of thrombotic complications in COVID-19

Screening for venous thromboembolism in patients with COVID-19

Acute splanchnic vein thrombosis in patients with COVID-19: A systematic review

Contact Info

Product

Resources

About