Venous Thrombosis Among Critically Ill Patients With Coronavirus Disease 2019 (COVID-19)

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) was identified as a new coronavirus causing pneumonia and acute respiratory distress syndrome. It has become a pandemic, spreading particularly quickly across Europe and the US. Most deaths are related to severe acute respiratory distress syndrome, but other organ failures, such as acute kidney failure and acute cardiac injury, seem also related to the disease. 1 Inflammatory response is highly increased in coronavirus disease 2019 (COVID-19) infection, and inflammation is known to favor thrombosis. High dimerized plasmin fragment D (D-dimer) levels and procoagulant changes in coagulation pathways were reported among patients with severe COVID-19. 2,3 An elevated rate of venous and arterial thrombotic events associated with COVID-19 infection has also been reported. 4,5 This case series reports a systematic assessment of deep vein thrombosis among patients in an intensive care unit (ICU) in France with severe COVID-19. MethodsThis case series was approved by the ethical committee of the Centre Cardiologique du Nord, which granted a waiver of consent because the research presented no risk of harm and required no procedures for which consent is normally required outside a research context. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. Patients with severe COVID-19 pneumonia were admitted to our ICU located in the suburban Paris area from mid-March 2020 to the beginning of April 2020. All patients had acute respiratory distress syndrome according to the Berlin definition and required mechanical ventilation.We prospectively performed a venous ultrasonogram of the inferior limbs for all patients at admission to our ICU, considering previous data that showed increased levels of inflammatory markers, preliminary reports from the intensive care community signaling frequent events of deep vein thrombosis in ICU patients with COVID-19 at the time we received our first patients, and the high rate of deep vein thrombosis found among the first patients with COVID-19 admitted to our unit.Considering the high prevalence of venous thrombosis at admission, we systematically repeated venous ultrasonography after 48 hours if the first examination returned normal results. As recommended, all patients received anticoagulant prophylaxis at hospital admission. Statistical analyses were conducted in Prism version 5.0 (GraphPad) and Excel 365 (Microsoft Corp). Statistical significance was set at P < .05, and all tests were 2-tailed. ResultsA total of 34 consecutive patients were included in this study. COVID-19 diagnosis was confirmed with polymerase chain reaction on nasopharyngeal swabs of 26 patients (76%); 8 patients (24%) had a negative result on polymerase chain reaction but had a typical pattern of COVID-19 pneumonia on chest computed tomography scan. Mean (SD) age was 62.2 (8.6) years, and 25 patients (78%) were men. Major comorbidities were diabetes (15 [44%]), hypertension (13 [38%]), and o...

Venous Thrombo-Embolism in Hospitalized SARS-CoV-2 Patients Treated with Three Different Anticoagulation Protocols: Prospective Observational Study

“…Data regarding VTE rate outside the ICU are more limited, but also suggest a possibly increased rate (range 3% to 6%) [ 16 , 25 ]. Other studies focused on Covid-19 patients also show a higher rate of DVT (65–69% in ICU patients [ 26 , 27 ], 11.9–21% in general ward patients [ 9 , 28 , 29 ]). Unlike what has been described by other authors [ 9 , 28 ], in our study most DVTs were proximal (84.6%) and only 15.4% of DVTs were distal.…”

Predictors of COVID-19 severity: a systematic review and meta-analysis

“…In addition, a study with a short follow-up period also reported the existence of a dynamic correlation between the D-dimer levels and the severity of COVID-19 72 . Furthermore, pulmonary embolism and deep vein thrombosis were also observed in patients with severe COVID-19 73 , 74 , which suggests that D-dimer might play a prominent role in governing the severity of COVID-19 patients.…”

Incidence of thrombosis and hemorrhage in hospitalized cancer patients with COVID‐19

“…Given that thrombo‐inflammation is the emerging basis of COVID‐19 coagulopathy, it is possible that the immunosuppressive effects of active cancer and cancer directed therapies modulated the thrombo‐inflammatory response. Prior reports of thrombotic events in hospitalized patients included a limited number of cancer patients with severe COVID‐19, which limits extrapolation 26,27 . In a retrospective series from Italy, there were only two patients with active cancer requiring ICU‐level care 28 .…”