Hemorrhage and venous thromboembolism in critically ill patients with COVID-19

Abstract

Objective: The majority of patients with COVID-19 showed mild symptoms. However, approximately 5% of them were critically ill and require intensive care unit admission for advanced life supports. Patients in the intensive care unit were high risk for venous thromboembolism and hemorrhage due to the immobility and anticoagulants used during advanced life supports. The aim of the study was to report the incidence and treatments of the two complications in such patients. Method: Patients with COVID-19 (Group 1) and patients with community-acquired pneumonia (Group 2) that required intensive care unit admission were enrolled in this retrospective study. Their demographics, laboratory results, ultrasound findings and complications such as venous thromboembolism and hemorrhage were collected and compared. Results: Thirty-four patients with COVID-19 and 51 patients with community-acquired pneumonia were included. The mean ages were 66 and 63 years in Groups 1 and 2, respectively. Venous thromboembolism was detected in 6 (18%) patients with COVID-19 and 18 (35%) patients with community-acquired pneumonia (P = 0.09). The major type was distal deep venous thrombosis. Twenty-one bleeding events occurred in 12 (35%) patients with COVID-19 and 5 bleeding events occurred in 5 (10%) patients with community-acquired pneumonia, respectively (P = 0.01). Gastrointestinal system was the most common source of bleeding. With the exception of one death due to intracranial bleeding, blood transfusion with or without surgical/endoscopic treatments was able to manage the bleeding in the remaining patients. Multivariable logistic regression showed increasing odds of hemorrhage with extracorporeal membrane oxygenation (odds ratio: 13.9, 95% confidence interval: 4.0–48.1) and COVID-19 (odds ratio: 4.7, 95% confidence interval: 1.2–17.9). Conclusion: Venous thromboembolism and hemorrhage were common in both groups. The predominant type of venous thromboembolism was distal deep venous thrombosis, which presented a low risk of progression. COVID-19 and extracorporeal membrane oxygenation were risk factors for hemorrhage. Blood transfusion with or without surgical/endoscopic treatments was able to manage it in most cases.

Analysis of influencing factors of community-acquired pneumonia with deep venous thrombosis in elderly communities

“…However, there was no difference in the proportion of males and females with DVT (24.9/29.2). Qiu (14) found that VTE was detected in 6 (18%) patients with coronavirus disease 2019 (COVID-19) and 18 (35%) patients with CAP. The major type was distal DVT.…”

Coronavirus Disease in the Abdomen

“…In the abdomen, involvement of the arterial vasculature (aorta, iliac, celiac, common hepatic, and superior mesenteric arteries) as well as venous structures (portal and renal veins) has been described ( Fig. 8 ) [ 20 , [58] , [59] , [60] ]. Visceral consequences of non-visualized microembolic events include renal infarcts, splenic infarcts, and bowel ischemia, as described above [ 1 , 58 ].…”

Venous thromboembolic events in the setting of extracorporeal membrane oxygenation support in adults: A systematic review

“…Studies outlining the incidence of VTE in Covid-19 patients alone depict that there is a remarkable incidence of VTE and intracranial bleeding [36]. Qiu et al compared the incidence of VTE and hemorrhage in patients with Covid-19 and patients with community acquired pneumonia [9]. VTE was frequent in both cohorts, but the Covid-19 patients had a higher rate of hemorrhage and ECMO was a risk factor for hemorrhage [9].…”

“…Qiu et al compared the incidence of VTE and hemorrhage in patients with Covid-19 and patients with community acquired pneumonia [9]. VTE was frequent in both cohorts, but the Covid-19 patients had a higher rate of hemorrhage and ECMO was a risk factor for hemorrhage [9]. Weir-McCall et al found that venous thrombosis was more common in patients with Covid-19-related pneumonia than non-Covid-19-related pneumonia [37].…”

“…Due to the SARS-CoV-2 (Covid-19) pandemic, the use of ECMO has become even more widespread. Patients on ECMO for Covid-19-associated respiratory failure have experienced, in some cases, higher rates of thrombosis and hemorrhage [9,10]. The overall increase in the use of ECMO therapy has triggered a growing interest in diagnosis, treatment, and preventative strategies for thromboembolic events.…”