Incidence of thrombotic complications in critically ill ICU patients with COVID-19
Open accessAbstract
Introduction COVID-19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation. Reports on the incidence of thrombotic complications are however not available.Methods We evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction or systemic arterial embolism in all COVID-19 patients admitted to the ICU of 2 Dutch university hospitals and 1 Dutch teaching hospital.Results We studied 184 ICU patients with proven COVID-19 pneumonia of whom 23 died (13%), 22 were discharged alive (12%) and 139 (76%) were still on the ICU on April 5th 2020. All patients received at least standard doses thromboprophylaxis. The cumulative incidence of the composite outcome was 31% (95%CI 20-41), of which CTPA and/or ultrasonography confirmed VTE in 27% (95%CI 17-37%) and arterial thrombotic events in 3.7% (95%CI 0-8.2%). PE was the most frequent thrombotic complication (n = 25, 81%). Age (adjusted hazard ratio (aHR) 1.05/per year, 95%CI 1.004-1.01) and coagulopathy, defined as spontaneous prolongation of the prothrombin time > 3 s or activated partial thromboplastin time > 5 s (aHR 4.1, 95%CI 1.9-9.1), were independent predictors of thrombotic complications.Conclusion The 31% incidence of thrombotic complications in ICU patients with COVID-19 infections is remarkably high. Our findings reinforce the recommendation to strictly apply pharmacological thrombosis prophylaxis in all COVID-19 patients admitted to the ICU, and are strongly suggestive of increasing the prophylaxis towards high-prophylactic doses, even in the absence of randomized evidence.
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Around 30% of SARS-CoV-2 patients in intensive care units display thrombotic complications.
“For example, around 30% of SARS‐Cov‐2 patients in intensive care units display thrombotic complications (Klok et al, 2020), and senescence is reported to promote clotting via the secretion of certain SASP molecules (Wiley et al, 2019).”
From The struggle of a good friend getting old: cellular senescence in viral responses and therapy (2021) · cites this paper as Klok et al, 2020
All neurological symptoms together with acute cerebrovascular disorder are correlated with the consequences of strokes or micro-strokes.
“Together with an acute cerebrovascular disorder, all symptoms are correlated with the consequences of strokes or micro-strokes [23].”
From Hyperactivation of P2X7 receptors as a culprit of COVID-19 neuropathology (2021) · cites this paper as [23]
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- Authors
- Klok, F. A., Kruip, M. J. H. A., van der Meer, N. J. M., Arbous, M. S., Gommers, D. A. M. P. J., Kant, K. M., Kaptein, F. H. J., van Paassen, J., Stals, M. A. M., Huisman, M. V., & Endeman, H.
- Affiliations
- Leiden University Medical Center (NL)
- Erasmus MC (NL)
- Amphia Ziekenhuis (NL)
- Corresponding author
- Klok, F.A.
- ORCID
- Venue
- Thrombosis Research
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 191
- Pages
- 145-147
- ISSN
- 0049-3848 (ISSN-L)
- PMC
- PMC7146714
- OpenAlex
- W3015863623
- Cited by
- 5,028
- References
- 7
- Citations by year
- 2026: 61 · 2025: 143 · 2024: 248 · 2023: 461 · 2022: 837 · 2021: 1443 · 2020: 1826 · 2019: 1 · 2018: 1 · 2013: 1 · 2012: 1
- FWCI
- 149.82
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thrombosis Research (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- Leiden Repository (Leiden University) (submittedVersion, cc-by)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
- Funders
- Bayer
- Bristol-Myers Squibb
- Boehringer-Ingelheim
- Daiichi-Sankyo
- MSD and Actelion
- Dutch Heart foundation
- Dutch Thrombosis association
- ZonMW Dutch Healthcare Fund
- Pfizer-BMS
- Bayer Health Care
- Aspen
- Pfizer
- Sobi
- The Netherlands Organisation for Health Research and Development
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- COVID-19 pandemic, thrombotic complications, venous thromboembolism, pulmonary embolism, deep vein thrombosis, arterial thromboembolism, ischemic stroke, myocardial infarction, critically ill patients, thromboprophylaxis, coagulopathy, incidence, risk factors
- MeSH terms
- COVID-19, Acute Disease, Anticoagulants, Arterial Occlusive Diseases, Brain Ischemia, Embolism, Female, Hospitals, Teaching, Hospitals, University, Humans, Male, Middle Aged, Myocardial Infarction, Netherlands, Pneumonia, Viral, Pulmonary Embolism, Incidence, Critical Illness, Coronavirus Infections, Thrombophilia, Venous Thrombosis, Pandemics
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