Prevalence of deep venous thrombosis in ventilated COVID-19 patients: a mono-center cross-sectional study

Pellens, Ben; Romont, Margo; Tornout, Michiel Van; Mey, Nathalie De; Dubois, Jasperina; Pauw, Ilse De; Ramaekers, Dirk; Stessel, Björn

doi:10.21037/jeccm-20-62

Cited by 7 publications

(10 citation statements)

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“… Author Country Study Design Sample Size (Total = 12132) VTE/PE/DVT (%) Total = 2029 Age (mean ± SD) years Male (%) BMI (mean ± SD) kg/m2 HTN (%) DM (%) Obesity (%) CVD (%) Smokers (%) Mortality (%) LoS (mean ± SD) days ICU admission Mechanical Ventilation Torres A(16) Mexico cohort 30 DVT; 9 ( 30 ) 60.3 ± 35 vs 55.6 ± 32.6 8 ( 89 ) vs 15 ( 71 ) 32.4 ± 17 vs 29.4 ± 15.7 5 ( 56 ) vs 6 ( 29 ) 2 ( 22 ) vs 11 ( 52 ) 6 ( 66 ) vs 6 ( 29 ) 1 ( 11 ) vs 4 ( 20 ) NA 3 ( 33 ) vs 3 ( 14 ) 7.5 ± 14 vs 12.3 ± 20.7 NA NA Santoliquido A(17) Italy cohort study 84 DVT;10 ( 12 ) 72.0 ± 11.3 vs 67.0 ± 13.8 7 ( 70 ) vs 54 ( 73 ) NA 6 ( 60 ) vs 39 (52.7) 1 ( 10 …”

Section: Resultsmentioning

confidence: 99%

Clinical characteristics and outcomes of venous thromboembolism in patients hospitalized for COVID-19: Systematic review and meta-analysis

Henrina¹,

Putra²,

Cahyadi³

et al. 2021

Thrombosis Update

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Venous thromboembolism is prevalent in hospitalized COVID-19 patients. Through systematic review and meta-analysis, we have investigated the differences in clinical characteristics and outcome of hospitalized COVID-19 patients with (+) and without (-) venous thromboembolism (VTE). 45 studies with a total of 8859 patients were included in the qualitative synthesis. Subsequently, 38 studies with a total of 7847 patients, were quantitatively analysed. There was no mortality difference between the VTE (-) and VTE (+) hospitalized COVID-19 patients (RR1.32 (0.97, 1.79); 0.07; I 2 64%, p <0.001). Patients with VTE (+) were more likely to get admitted to the intensive care unit (RR1.77 (1.26, 2.50); p <0.001; I 2 63%, p = 0.03) and mechanically ventilated (RR 2.35 (1.22, 4.53); p =0.01; I 2 88%, p <0.001). Moreover, male gender (RR 1.19 (1.14,1.24), p <0.001; I2 0%, p =0.68), increased the risk of VTE. Regarding patients lab values’, VTE (+) was significantly associated with higher white blood cell, neutrophil count, D-Dimer, alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and C-reactive protein (CRP), along with prolonged prothrombin time. On the contrary, VTE (+) was associated with lower albumin and neutrophil-lymphocyte ratio (NLR). This findings provide the initial framework for risk stratification of hospitalized COVID-19 patients with VTE.

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Section: Resultsmentioning

confidence: 99%

Clinical characteristics and outcomes of venous thromboembolism in patients hospitalized for COVID-19: Systematic review and meta-analysis

Henrina¹,

Putra²,

Cahyadi³

et al. 2021

Thrombosis Update

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“…All patients admitted to the ICU from March 13 th , 2020, until March 30 th , 2020, received routine low-dose pharmacological VTE prophylaxis, i.e., once-daily subcutaneous injection of nadroparin calcium 2850 IU, according to the current guidelines in critically ill patients [ 14 , 15 ]. On March 30 th , 2020, a high incidence of deep venous thrombosis was discovered [ 16 ], for which we changed our prophylactic anticoagulation protocol from prophylactic to intermediate dosages of low molecular weight heparin (LMWH) with plasma anti-Xa activity monitoring [ 17 ]. Anti-Xa activity was targeted at 0.3–0.5 IU/ml in patients without echographic findings of deep venous thrombosis (DVT) and 0.4–1 IU/ml in patients with screening duplex positive for DVT.…”

Section: Methodsmentioning

confidence: 99%

Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV Score in COVID-19 Patients

Vandenbrande

Verbrugge

Bruckers

et al. 2021

Critical Care Research and Practice

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Background. Severity scoring systems are inherent to ICU practice for multiple purposes. Acute Physiology and Chronic Health Evaluation (APACHE) scoring systems are designed for ICU mortality prediction. This study aims to validate APACHE IV in COVID-19 patients admitted to the ICU. Methods. All COVID-19 patients admitted to the ICU between March 13, 2020, and October 17, 2020, were retrospectively analyzed. APACHE II and APACHE IV scores as well as SOFA scores were calculated within 24 hours after admission. Discrimination for mortality of all three scoring systems was assessed by receiver operating characteristic curves. Youden index was determined for the scoring system with the best discriminative performance. The Hosmer–Lemeshow goodness-of-fit test was used to assess calibration. All analyses were performed for both the overall population as in a subgroup treated with anti-Xa adjusted dosages of LMWHs. Results. 116 patients were admitted to our ICU during the study period. 13 were excluded for various reasons, leaving 103 patients in the statistical analysis of the overall population. 57 patients were treated with anti-Xa adjusted prophylactic dosages of LMWH and were supplementary analyzed in a subgroup analysis. APACHE IV had the best discriminative power of the three scoring systems, both in the overall population (APACHE IV ROC AUC 0.67 vs. APACHE II ROC AUC 0.63) as in the subgroup (APACHE IV ROC AUC 0.82 vs. APACHE II ROC AUC 0.7). This model exhibits good calibration. Hosmer–Lemeshow p values for APACHE IV were 0.9234 for the overall population and 0.8017 for the subgroup. Calibration p values of the APACHE II score were 0.1394 and 0.6475 for the overall versus subgroup, respectively. Conclusions. APACHE IV provided the best discrimination and calibration of the considered scoring systems in critically ill COVID-19 patients, both in the overall group and in the subgroup with anti-Xa adjusted LMWH doses. Only in the subgroup analysis, discriminative abilities of APACHE IV were very good. This trial is registered with NCT04713852.

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“…All patients were treated with routine low dose pharmacological venous thromboembolism (VTE) prophylaxis with LMWH according to the current guidelines in critically ill patients [8,9]. Nevertheless, deep vein thrombosis (DVT) screening using duplex ultrasound of all intubated and mechanically ventilated COVID-19 patients treated at one ward on March 29th, revealed a prevalence of DVT of more than 65% [10]. These findings suggested that thrombo-embolic phenomenona may be another, at that time lesswell known, major cause of death of severe COVID-19 infection.…”

Section: Introductionmentioning

confidence: 99%

Impact of implementation of an individualised thromboprophylaxis protocol in critically ill ICU patients with COVID-19: A longitudinal controlled before-after study

Stessel

Vanvuchelen

Bruckers

et al. 2020

Thrombosis Research

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Introduction An individualised thromboprophylaxis was implemented in critically ill patients suffering from coronavirus disease 2019 (COVID-19) pneumonia to reduce mortality and improve clinical outcome. The aim of this study was to evaluate the effect of this intervention on clinical outcome. Methods In this mono-centric, controlled, before-after study, all consecutive adult patients with confirmed COVID-19 pneumonia admitted to ICU from March 13th to April 20th 2020 were included. A thromboprophylaxis protocol, including augmented LMWH dosing, individually tailored with anti-Xa measurements and twice-weekly ultrasonography screening for DVT, was implemented on March 31th 2020. Primary endpoint is one-month mortality. Secondary outcomes include two-week and three-week mortality, the incidence of VTE, acute kidney injury and continuous renal replacement therapy (CRRT). Multiple regression modelling was used to correct for differences between the two groups. Results 46 patients were included in the before group, 26 patients in the after group. One month mortality decreased from 39.13% to 3.85% (p < 0.001). After correction for confounding variables, one-month mortality was significantly higher in the before group (p = 0.02, OR 8.86 (1.46, 53.75)). The cumulative incidence of VTE and CRRT was respectively 41% and 30.4% in the before group and dropped to 15% (p = 0.03) and 3.8% (p = 0.01), respectively. After correction for confounding variables, risk of VTE (p = 0.03, 6.01 (1.13, 32.12)) and CRRT (p = 0.02, OR 19.21 (1.44, 255.86)) remained significantly higher in the before group. Conclusion Mortality, cumulative risk of VTE and need for CRRT may be significantly reduced in COVID-19 patients by implementation of a more aggressive thromboprophylaxis protocol. Future research should focus on confirmation of these results in a randomized design and on uncovering the mechanisms underlying these observations. Registration number NCT04394000 .

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Prevalence of deep venous thrombosis in ventilated COVID-19 patients: a mono-center cross-sectional study

Cited by 7 publications

References 0 publications

Clinical characteristics and outcomes of venous thromboembolism in patients hospitalized for COVID-19: Systematic review and meta-analysis

Clinical characteristics and outcomes of venous thromboembolism in patients hospitalized for COVID-19: Systematic review and meta-analysis

Validation of the Acute Physiology and Chronic Health Evaluation (APACHE) II and IV Score in COVID-19 Patients

Impact of implementation of an individualised thromboprophylaxis protocol in critically ill ICU patients with COVID-19: A longitudinal controlled before-after study

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