Erhöhtes Risiko für tiefe Beinvenenthrombosen bei Intensivpatienten mit CoViD-19-Infektion? – Erste Daten

Zerwes, Sebastian; Cancino, F Hernandez; Liebetrau, Dominik; Goßlau, Yvonne; Warm, Tobias Dominik; Märkl, Bruno; Hyhlik‐Dürr, A.

doi:10.1007/s00104-020-01222-7

Cited by 24 publications

(18 citation statements)

References 22 publications

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“…32,33 Our findings are similar to prior studies reporting rates of thromboembolic events ranging from 18% to 69% in Covid-19 patients in ICU. 10,12,[15][16][17][18][19][21][22][23][24][25][26] Lower extremity DVT rates in ICU Covid-19 patients show wide variability with values as low as 2% or less to as high as 23% to 54% per multiple reports. 10,12,[15][16][17][18][19][22][23][24][25][26] Klok et al reported 49% cumulative incidence of thromboembolic complications, of which, only 3 were lower extremity DVTs.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Per published reports, the cumulative incidence of VTE (deep venous thrombosis and pulmonary embolism) in Covid-19 patients varies from 7.7% up to 69%. [10][11][12][16][17][18][19][20][21][22][23][24][25][26][27] The pathophysiology of CAC includes 2 mechanisms: systemic inflammation or cytokine storm causing endothelial cell activation and injury in the lung micro vasculature leading to pulmonary micro thrombosis and a hypercoagulable state leading to large vessel thrombosis. 3,8,28 Recent autopsy series of Covid-19 patients showed histologic pattern of diffuse alveolar damage, severe endothelial injury, widespread alveolar capillary thrombosis, micro angiopathy and angiogenesis.…”

Section: Introductionmentioning

confidence: 99%

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Thromboembolic Events and Role of Point of Care Ultrasound in Hospitalized Covid-19 Patients Needing Intensive Care Unit Admission

Kapoor

Chand

Dieiev

et al. 2020

J Intensive Care Med

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Background: Covid-19 associated coagulopathy (CAC) is associated with prothrombotic state and thromboembolism. However, true incidence of thromboembolic events is difficult to determine in the ICU setting. The aim of our study was to investigate the cumulative incidence of thromboembolic events in Covid-19 patients needing intensive care unit (ICU) admission and assessing the utility of point of care ultrasound (POCUS) to screen for and diagnose lower extremity deep venous thrombosis (DVT). Methods: We conducted a prospective observational study between April 22nd and May 26th, 2020 where all adult patients with the diagnosis of Covid-19 pneumonia admitted to 8 ICUs of Montefiore Medical Center were included. POCUS exam was performed on all patients at day 1 of ICU admission and at day 7 and 14 after the first exam. Results: The primary outcome was to study the cumulative incidence of thromboembolic events in Covid-19 patients needing ICU admission. A total of 107 patients were included. All patients got POCUS exam on day 1 in the ICU, 62% got day 7 and 41% got day 14 exam. POCUS diagnosed 17 lower extremity DVTs on day 1, 3 new on day 7 and 1 new on day 14. Forty patients developed 52 thromboembolic events, with the rate of 37.3%. We found a high 45-day cumulative incidence of thromboembolic events of 37% and a high 45-day cumulative incidence of lower and upper extremity DVT of 21% and 10% respectively. Twelve (30%) patients had failure of therapeutic anticoagulation. Occurrence of a thromboembolic event was not associated with a higher risk of mortality (HR 1.08, p value = .81). Conclusions: Covid-19 patients in ICU have a high cumulative incidence of thromboembolic events, but not associated with higher mortality. POCUS is an excellent tool to help screen and diagnose DVT during a pandemic.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Thromboembolic Events and Role of Point of Care Ultrasound in Hospitalized Covid-19 Patients Needing Intensive Care Unit Admission

Kapoor

Chand

Dieiev

et al. 2020

J Intensive Care Med

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“… 26 The VTE group of COVID-19 patients was different from the non-VTE group in terms of D-dimer level, neutrophil-to-lymphocyte ratio (NLR), lymphocyte count, lactate dehydrogenase level, prothrombin time (PT), etc. 3 26 27 A significant increase in D-dimer is a sign of activation of coagulation and fibrinolysis, and is a good indicator for identifying high-risk populations with VTE, 28 which can be used as a highly sensitive test but with low specificity for detection of an active thrombotic process. 29 A study including 81 critically infected patients with COVID-19 concluded that D-dimer levels >1,500 ng/mL (normal range: 0.0–0.5 g/mL) had a sensitivity of 85.0%, a specificity of 88.5%, and a negative predictive value of 94.7% for detecting VTE events.…”

Section: Introductionmentioning

confidence: 99%

Venous Thromboembolism in COVID-19

Schulman

Konstantinides

2020

Thromb Haemost

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The coronavirus disease 2019 (COVID-19) is our latest pandemic, preceded by the H1N1 swine flu in 2009, which lasted approximately 19 months. One of the special characteristics of COVID-19 is the propensity to cause venous thromboembolism (VTE). Thromboinflammation seems to play a prominent role in the pathogenesis. We will here review some mechanisms in the pathogenesis and discuss some hematological biomarkers, and also whether they serve as useful risk factors for VTE. The role of general risk assessment models for medically ill patients specifically in COVID-19 is appraised. The type of prophylaxis and particularly whether standard or augmented doses of chemoprophylaxis should be used is reviewed based on available evidence. We are also comparing recommendations from 10 different guidance or position/consensus statements. Treatment recommendations for patients with COVID-19 and pulmonary embolism are discussed with current general treatment guidelines as reference. Specifics for patients with COVID-19 are pointed out and the potential role of thrombolytic treatment is explored.

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“…The diagnosis of COVID-19 in most studies required the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time polymerase chain reaction (RT-PCR), but some were based on high clinical suspicion without the PCR results. In the clinical studies, 16 and 5 studies reported the incidences of outcomes only in the ICU (2,3,8,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) or non-ICU settings (27)(28)(29)(30)(31), respectively. Seven studies reported the incidence of outcomes in the ICU, and non-ICU settings.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Incidence of thromboembolism in patients with COVID-19: a systematic review and meta-analysis

Boonyawat

Chantrathammachart

Numthavej

et al. 2020

Preprint

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Background: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, the incidence of thromboembolism has been increasingly reported. The aim of this systematic review was to explore the incidence of venous and arterial thromboembolism among COVID-19 patients requiring hospitalization.Methods: Medline, Embase, Scopus, and grey literature were searched until May 2020. Observational studies reported on the incidence of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT) or arterial thromboembolism (ATE) were included. The pool incidences and their 95% confidence intervals (CI) were calculated using the random-effects model.Results: A total of 36 studies were included. In the intensive care unit (ICU) setting, the pooled incidence of VTE was 28% (95% CI, 22-34%). Subgroups based on compression ultrasound (CUS) screening revealed a higher incidence of DVT in the CUS screening group than in the no CUS screening group (32% [95% CI, 18-45%] vs. 6% [95% CI, 4-9%]). The pooled incidence of ATE in ICU was 3% (95% CI, 2-5%). In the non-ICU setting, the pooled incidence of VTE was 10% (95% CI, 6-14%,).Conclusions:The incidence of VTE in COVID-19 patients was higher in the ICU setting than in the non-ICU setting, and also significantly higher in studies that incorporated the CUS screening protocol. The incidence of ATE in the ICU setting was low. VTE prophylactic measures should be given to all hospitalized patients diagnosed with COVID-19.

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Erhöhtes Risiko für tiefe Beinvenenthrombosen bei Intensivpatienten mit CoViD-19-Infektion? – Erste Daten

Cited by 24 publications

References 22 publications

Thromboembolic Events and Role of Point of Care Ultrasound in Hospitalized Covid-19 Patients Needing Intensive Care Unit Admission

Thromboembolic Events and Role of Point of Care Ultrasound in Hospitalized Covid-19 Patients Needing Intensive Care Unit Admission

Venous Thromboembolism in COVID-19

Incidence of thromboembolism in patients with COVID-19: a systematic review and meta-analysis

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