A Retrospective Analysis of Thromboembolic Phenomena in Mechanically Ventilated Patients with COVID-19

Abstract

Background. Recent studies have shown an increased prevalence of thromboembolic disease in critically ill patients with the novel SARS-CoV-2 disease (COVID-19). However, the use of enhanced anticoagulation therapy in these patients remains controversial. Objectives. To determine the incidence of thromboembolic phenomena (TEP) and hemorrhagic events (HEs) in intensive care unit (ICU) COVID-19 patients. Methods. One hundred and sixty ICU patients with COVID-19 were enrolled. Clinical examination results, laboratory data, and imaging studies (computed tomography/Doppler ultrasound scans) for these patients were retrospectively collected and analyzed. Outcome measures including days on mechanical ventilation, ICU length of stay, and day-28 mortality were recorded. Results. Sixty patients (37.5%) developed TEP including thirty patients with deep vein thrombosis, 55 patients with pulmonary embolism, and 7 patients with arterial thromboembolism. Cardiac arrhythmias, lymphocytopenia, and increased D-dimers were more frequently observed in the TEP group compared to the non-TEP group of patients (all p < 0.05 ). The sensitivity, specificity, and positive and negative predictive values of a cutoff D-dimer level of 3.0 μg/mL for predicting PE were 74.5%, 95.1%, 86.8%, and 91.9%, respectively. Thirteen patients experienced HEs, which were more frequently observed in the TEP group ( p < 0.05 ). Twenty-eight-day mortality was higher in the TEP group (60%) compared to the non-TEP group (30%) of patients ( p = 0.02 ). Conclusions. The rates of TEP and HEs in mechanically ventilated critically ill COVID-19 patients were 37. 5% and 8.1%. Twenty-eight-day mortality was higher in the TEP group (60%) compared to the non-TEP group (30%) of patients.

D-Dimer Assessment to Predict Pulmonary Embolism in ICU Patients with COVID-19 Pneumonia

“…A literature search revealed three studies that were performed in COVID-19 ICU populations and reported the sensitivity and specificity of D-dimers alone (not as part of a multi-item scale) for the prediction of PE alone (not for venous thromboembolism as a whole) [2,12,13]. Table 2 summarizes the main findings of these studies combined with the present study.…”

An Imaging Overview of COVID-19 ARDS in ICU Patients and Its Complications: A Pictorial Review

“…Hemorrhages are more frequently observed in patients receiving therapeutic anticoagulation for the prevention of venous thromboembolism [105], but both high levels of proinflammatory cytokines and widespread endothelial cell damage may contribute to their occurrence [106]. Moreover, anticoagulant therapy to prevent the ECMO circuit from clotting and consequently minimize the risk of thromboembolic events may lead to an increased risk for spontaneous hemorrhages anywhere in the body [27].…”