High Prevalence of Deep Vein Thrombosis in Mechanically Ventilated COVID-19 Patients

Voicu, Sébastian; Bonnin, Philippe; Stépanian, Alain; Chousterman, Benjamin; Gall, Arthur Le; Malissin, Isabelle; Deye, Nicolas; Siguret, V.; Mebazaa, Alexandre; Mégarbane, Bruno

doi:10.1016/j.jacc.2020.05.053

Cited by 86 publications

(113 citation statements)

References 4 publications

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“…The overall incidence of venous thromboembolism (VTE) in patients with COVID‐19 is unknown. Studies evaluating incidence have been limited to case reports and case series, with estimates ranging from as low as 1% in the general wards to as high as 69% in intensive care units using screening ultrasound 3‐7,10‐27 . The limited data present a challenge for health care providers in prevention, diagnosis, and management of VTE in patients with COVID‐19.…”

Section: Introductionmentioning

confidence: 99%

Anticoagulation practice patterns in COVID‐19: A global survey

Rosovsky

Sanfilippo

Wang

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Background Best practice for prevention, diagnosis, and management of venous thromboembolism (VTE) in patients with coronavirus disease 2019 (COVID‐19) is unknown due to limited published data in this population. Objectives We aimed to assess current global practice and experience in management of COVID‐19–associated coagulopathy to identify information to guide prospective and randomized studies. Methods Physicians were queried about their current approach to prophylaxis, diagnosis, and treatment of VTE in patients with COVID‐19 using an online survey tool distributed through multiple international organizations between April 10 and 14, 2020. Results Five hundred fifteen physicians from 41 countries responded. The majority of respondents (78%) recommended prophylactic anticoagulation for all hospitalized patients with COVID‐19, with most recommending use of low‐molecular‐weight heparin or unfractionated heparin. Significant practice variation was found regarding the need for dose escalation of anticoagulation outside the setting of confirmed or suspected VTE. Respondents reported the use of bedside testing when unable to perform standard diagnostic imaging for diagnosis of VTE. Two hundred ninety‐one respondents reported observing thrombotic complications in their patients, with 64% noting that the complication was pulmonary embolism. Of the 44% of respondents who estimated incidence of thrombosis in patients with COVID‐19 in their hospital, estimates ranged widely from 1% to 50%. One hundred seventy‐four respondents noted bleeding complications (34% minor bleeding, 14% clinically relevant nonmajor bleeding, and 12% major bleeding). Conclusion Well‐designed epidemiologic studies are urgently needed to understand the incidence and risk factors of VTE and bleeding complications in patients with COVID‐19. Randomized clinical trials addressing use of anticoagulation are also needed.

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Section: Introductionmentioning

confidence: 99%

Anticoagulation practice patterns in COVID‐19: A global survey

Rosovsky

Sanfilippo

Wang

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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“…43,44 Intravascular coagulation may occur systemically but may be particularly pronounced, or perhaps consequential, in the pulmonary vasculature. 6 The heterogeneous rates of deep venous thrombosis observed so far in patients with COVID-19 30,45,46 may suggest that some of the thrombotic events observed in the lungs may be caused by in situ pulmonary thrombosis rather than pulmonary embolism, which deserves further study. 47 Compared with patients who died from influenza A H1N1 pneumonia in the 2009 pandemic, alveolar capillary microthrombi have been reported to be 9 times more prevalent in lungs from patients with COVID-19 who died with respiratory failure.…”

Section: Microcirculatory Thrombosismentioning

confidence: 99%

Anticipating and managing coagulopathy and thrombotic manifestations of severe COVID-19

Godoy

Goligher

Lawler

et al. 2020

CMAJ

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(COVID-19), the disease resulting from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), exhibits a broad spectrum of manifestations and severity. Although most patients do not require admission to hospital, about 10%-15% of symptomatic patients are admitted, of whom about 20% receive intensive care. 1 Thrombosis is a prominent clinical feature of COVID-19, and between 5% and 30% of in-hospital patients develop a clinically apparent thrombotic event. 2-4 Emerging evidence suggests that endothelial injury resulting from SARS-CoV-2 cellular invasion and a subsequent dysregulated host response involving inflammatory and coagulation pathways plays a critical role in the progression of severe COVID-19. 5 Macrovascular and microvascular thrombosis may contribute to organ failure, multisystem injury and death. 6,7 However, the optimal prevention and treatment of thrombosis in COVID-19 remains uncertain. 8 We review emerging evidence regarding COVID-19 coagulopathy (Box 1) and discuss current therapeutic directions and unanswered questions.

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“…28 studies [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][29][30][31][32][34][35][36][37][38][39][40][41]43 were conducted in Europe, three 12,28,33 in the USA, and two 6,42 in Asia (table 1). 19 [12][13][14][15]17,[21][22][23]26,[28][29][30][31][33][34][35]37,38,…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…19 [12][13][14][15]17,[21][22][23]26,[28][29][30][31][33][34][35]37,38,40 were retrospective cohorts, 12 16,18,20,24,25,27,32,36,39,[41][42][43] were prospective cohorts, and two 6,19 were cross-sectional studies. 19 6,13,15,16,21,23,[27][28][29][30]32,33,[36][37][38][39][40][41]43 reported VTE in the ICU, while 14 studies…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Proximal Deep Vein Thrombosis and Pulmonary Embolism in COVID-19 Patients: A Systematic Review and Meta-Analysis Short Tittle: Venous Thromboembolism in COVID-19 Patients

Longchamp

Manzocchi‐Besson

Longchamp

et al. 2020

Preprint

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BACKGROUNGCOVID-19 appears to be associated with a high risk of venous thromboembolism (VTE). We aimed to systematically review and meta-analyze the risk of clinically relevant VTE in patients hospitalized for COVID-19. METHODSThis meta-analysis included original articles in English published from 01/01/2020 to 06/15/2020 in Pubmed/MEDLINE, Embase, Web of science, and Cochrane. Outcomes were major VTE, defined as any objectively diagnosed pulmonary embolism (PE) and/or proximal deep vein thrombosis (DVT). Primary analysis estimated the risk of VTE, stratified by acutely and critically ill inpatients. Secondary analyses explored the separate risk of proximal DVT and of PE; the risk of major VTE stratified by screening and by type of anticoagulation. RESULTSIn 33 studies (n=4’009 inpatients) with heterogeneous thrombotic risk factors, VTE incidence was 9% (95%CI 5-13%, I2=92.5) overall, and 21% (95%CI 14-28%, I2=87.6%) for patients hospitalized in the ICU. Proximal lower limb DVT incidence was 3% (95%CI 1-5%, I2= 87.0%) and 8% (95%CI 3-14%, I2=87.6%), respectively. PE incidence was 8% (95%CI 4-13%, I2=92.1%) and 17% (95%CI 11-25%, I2=89.3%), respectively. Screening and absence of anticoagulation were associated with a higher VTE incidence. When restricting to medically ill inpatients, the VTE incidence was 2% (95%CI 0-6%).CONCLUSIONSThe risk of major VTE among COVID-19 inpatients is high but varies greatly with severity of the disease. These findings reinforce the need for the use of thromboprophylaxis in all COVID-19 inpatients and for clinical trials testing different thromboprophylaxis regimens in subgroups of COVID-19 inpatients. TRIAL REGISTRATIONThe review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews (CRD42020193369).

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High Prevalence of Deep Vein Thrombosis in Mechanically Ventilated COVID-19 Patients

Cited by 86 publications

References 4 publications

Anticoagulation practice patterns in COVID‐19: A global survey

Anticoagulation practice patterns in COVID‐19: A global survey

Anticipating and managing coagulopathy and thrombotic manifestations of severe COVID-19

Proximal Deep Vein Thrombosis and Pulmonary Embolism in COVID-19 Patients: A Systematic Review and Meta-Analysis Short Tittle: Venous Thromboembolism in COVID-19 Patients

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