Thrombotic complications of patients admitted to intensive care with COVID-19 at a teaching hospital in the United Kingdom

Thomas, William; Varley, James; Johnston, Andrew James; Symington, Emily; Robinson, Mark; Sheares, Karen; Lavinio, Andrea; Besser, Martin

doi:10.1016/j.thromres.2020.04.028

Cited by 166 publications

(243 citation statements)

References 10 publications

Supporting

Mentioning

225

Contrasting

Unclassified

Order By: Relevance

“…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

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…One of the key clinical features of COVID19 is upregulation of the pro-thrombotic phenotype and microvascular complications, leading to COVID19-associated coagulopathy (7). This is characterized by venous, arterial, and microvascular thrombosis despite the use of anti-coagulant therapies (32)(33)(34)(35)(36)(37)(38). Our study provides compelling evidence of COVID19 associated changes in coagulation-related gene expression levels that may exacerbate thrombosis caused by endothelial cell injury and platelet activation in COVID19+ ICU patients (7).…”

Section: Discussionmentioning

confidence: 79%

Transcriptional Profiling of Leukocytes in Critically Ill COVID19 Patients: Implications for Interferon Response and Coagulation

Gill

Santos

O’Gorman

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: COVID19 is caused by the SARS-CoV-2 virus and has been associated with severe inflammation leading to organ dysfunction and mortality. Our aim was to profile the transcriptome in leukocytes from critically ill patients positive for COVID19 compared to those negative for COVID19 to better understand the COVID19 associated host response. For these studies, all patients admitted to our tertiary care intensive care unit (ICU) suspected of being infected with SARS-CoV-2, using standardized hospital screening methodologies, had blood samples collected at the time of admission to the ICU. Transcriptome profiling of leukocytes via ribonucleic acid sequencing (RNAseq) was then performed and differentially expressed genes as well as significantly enriched gene sets were identified.Results: We enrolled seven COVID19+ (PCR positive, 2 SARS-CoV-2 genes) and seven age- and sex-matched COVID19- (PCR negative) control ICU patients. Cohorts were well-balanced with the exception that COVID19- patients had significantly higher total white blood cell counts and circulating neutrophils and COVID19+ patients were more likely to suffer bilateral pneumonia. The mortality rate for this cohort of COVID19+ ICU patients was 29%. Transcriptional analysis revealed that when compared to COVID19- patients, the altered transcriptional responses of leukocytes in critically ill COVID19+ ICU patients appeared to be associated with multiple interrelated outcomes, including but not limited to robust interferon (IFN)-associated transcriptional responses, a marked decrease in the transcriptional activity of genes contributing to protein synthesis and the dysregulated expression of genes that contribute to coagulation, platelet activation, Toll-like receptor activation, neurotrophin signalling, and protein SUMOylation/ubiquitination. Conclusions: Our findings demonstrate that critically ill COVID19+ patients on day 1 of admission to the ICU display a unique leukocyte transcriptional profile that distinguishes them from COVID19- patients, providing guidance for future targeted studies exploring novel prognostic and therapeutic aspects of COVID19.

show abstract

“…The diagnosis of COVID-19 in most studies required the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time polymerase chain reaction (RT-PCR), but some were based on high clinical suspicion without the PCR results. In the clinical studies, 10 and 2 studies reported the incidences of outcomes only in the ICU (2,3,8,(13)(14)(15)(16)(17)(18)(19) or non-ICU settings (20,21), respectively. Six studies reported the incidence of outcomes in the ICU, and non-ICU settings.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…(4, 9, 10, 22-24) Five studies reported on both venous and arterial thrombosis. (2,13,15,17,23) Twenty studies reported only venous thrombotic events, and one study reported only arterial thrombotic events. (4) Among 15 in 17 studies reported venous thrombotic outcomes, utilized anticoagulant prophylaxis.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Incidence of thromboembolism in patients with COVID-19: a systematic review and meta-analysis

Boonyawat

Chantrathammachart

Numthavej

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, the incidence of thromboembolism has been increasingly reported. The aim of this systematic review was to explore the incidence of venous and arterial thromboembolism among COVID-19 patients requiring hospitalization. Methods Medline, Embase, Scopus, and grey literature were searched until May 2020. Observational studies reported on the incidence of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT) or arterial thromboembolism (ATE) were included. The pool incidences and their 95% confidence intervals (CI) were calculated using the random-effects model. Results A total of 26 studies were included. In the intensive care unit (ICU) setting, the pooled incidence of VTE was 27% (95% CI, 20–35%). Subgroups based on compression ultrasound (CUS) screening revealed a higher incidence of DVT in the CUS screening group than in the no CUS screening group (27% [95% CI, 20–35%] vs. 3% [95% CI, 1–5%]). The pooled incidence of ATE in ICU was 3% (95% CI, 2–4%). In the non-ICU setting, the pooled incidence of VTE was 8% (95% CI, 4–12%,). Conclusions The incidence of VTE in COVID-19 patients was higher in the ICU setting than in the non-ICU setting, and also significantly higher in studies that incorporated the CUS screening protocol. The incidence of ATE in the ICU setting was low. VTE prophylactic measures should be given to all hospitalized patients diagnosed with COVID-19, especially in the ICU setting.

show abstract

Thrombotic complications of patients admitted to intensive care with COVID-19 at a teaching hospital in the United Kingdom

Cited by 166 publications

References 10 publications

Anticoagulation practice patterns in COVID‐19: A global survey

Anticoagulation practice patterns in COVID‐19: A global survey

Transcriptional Profiling of Leukocytes in Critically Ill COVID19 Patients: Implications for Interferon Response and Coagulation

Incidence of thromboembolism in patients with COVID-19: a systematic review and meta-analysis

Contact Info

Product

Resources

About