Thrombosis and Bleeding After Implementation of an Intermediate-Dose Prophylactic Anticoagulation Protocol in ICU Patients With COVID-19: A Multicenter Screening Study

Abstract

Thrombosis and bleeding after implementation of an intermediate-dose prophylactic anticoagulation protocol in intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19): a multicenter screening study Background: Venous thromboembolism (VTE) is common among critically ill patients with COVID-19. Information regarding VTE prevalence and bleeding complications after implementation of intermediate-dose prophylactic anticoagulation in such patients is, however, limited. Methods: We performed a prospective, observational study in 6 ICUs in 2 university-affiliated teaching hospitals in Sweden. After implementation of an intermediate-dose prophylactic anticoagulation protocol, we performed ultrasound screening for proximal lower-extremity deep vein thrombosis (DVT) and collected routine computed tomography pulmonary angiography exam results. Results: A total of 100 COVID-19 patients were included from June 21, 2020, through February 18, 2021. During a median follow-up of 120 (IQR, 89-134) days, we found VTE in 37 patients with the majority (78.4%) being diagnosed after ICU arrival. Overall, 20 patients had proximal lower-extremity DVT with 95% being detected on ultrasound screening; 22 patients had pulmonary vascular thrombosis; and 4 patients had venous thrombosis at other sites. A total of 6 patients had both proximal lower-extremity DVT and pulmonary vascular thrombosis. On univariate logistic regression analysis of 14 baseline characteristics, only pre-existing heart failure was associated with VTE (OR 4.67, 95% CI 1.13-19.34). Major and non-major bleeding occurred in 10 and 18 patients, respectively. Conclusions: In our cohort of ICU patients with COVID-19, we observed a high prevalence of VTE and bleeding complications after implementation of intermediate-dose anticoagulation. In approximately half of patients, VTE was identified on screening ultrasound.

Effect of anticoagulation on the incidence of venous thromboembolism, major bleeding, and mortality among hospitalized COVID-19 patients: an updated meta-analysis

“…Even if VTE is not the direct cause of death, it may be an important cause. Lax Considering the high incidence of COVID-19 combined with VTE and the high mortality due to disease progression, prophylactic anticoagulation with higher doses than standard has been carried out in many hospitals (49,51), which may place patients at higher risk for major bleeding (13,15,52). Controversy exists regarding which thromboprophylaxis treatment can achieve better clinical benefits in hospitalized patients with COVID-19.…”

“…However, various dosages of prophylactic anticoagulation are used in practice to balance clinical benefit and bleeding risk. Still, no valid consensus has been reached regarding optimal anticoagulation dosage for VTE prevention in COVID-19 patients to achieve best efficacy and less hemorrhage event (12)(13)(14)(15)(16).…”

Trombose venosa profunda de membros inferiores em pacientes com covid-19

“…A análise dos tratamentos empregados para o manejo da TVP de membros inferiores em pacientes com covid-19 sugere que a administração precoce de anticoagulante profilático beneficiaria o prognóstico de pacientes críticos com pneumonia por covid-19 e, provavelmente, reduziria as taxas de eventos tromboembólicos. Entretanto, há controvérsias na literatura 14,28,30,41,44,45 .…”

Deep vein thrombosis of lower limbs in patients with COVID-19

“…However, there are inconsistencies in the literature. 14,28,30,41,44,45 The studies included in this review describe patients with COVID-19 of varying degrees of severity and from different population groups.…”