Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis
Open accessAbstract
Introduction We recently reported a high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 admitted to the intensive care units (ICUs) of three Dutch hospitals. In answering questions raised regarding our study, we updated our database and repeated all analyses.Methods We re-evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction and/or systemic arterial embolism in all COVID-19 patients admitted to the ICUs of 2 Dutch university hospitals and 1 Dutch teaching hospital from ICU admission to death, ICU discharge or April 22nd 2020, whichever came first.Results We studied the same 184 ICU patients as reported on previously, of whom a total of 41 died (22%) and 78 were discharged alive (43%). The median follow-up duration increased from 7 to 14 days. All patients received pharmacological thromboprophylaxis. The cumulative incidence of the composite outcome, adjusted for competing risk of death, was 49% (95% confidence interval [CI] 41-57%). The majority of thrombotic events were PE (65/75; 87%). In the competing risk model, chronic anticoagulation therapy at admission was associated with a lower risk of the composite outcome (Hazard Ratio [HR] 0.29, 95%CI 0.091-0.92). Patients diagnosed with thrombotic complications were at higher risk of all-cause death (HR 5.4; 95%CI 2.4-12). Use of therapeutic anticoagulation was not associated with all-cause death (HR 0.79, 95%CI 0.35-1.8).Conclusion In this updated analysis, we confirm the very high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 pneumonia.
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- Authors
- Klok, F. A., Kruip, M. J. H. A., van der Meer, N. J. M., Arbous, M. S., Gommers, D., 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
- 148-150
- ISSN
- 0049-3848 (ISSN-L)
- PMC
- PMC7192101
- OpenAlex
- W3021591080
- Cited by
- 1,601
- References
- 13
- Citations by year
- 2026: 15 · 2025: 31 · 2024: 76 · 2023: 123 · 2022: 290 · 2021: 508 · 2020: 545 · 2019: 3 · 2018: 3 · 2015: 1
- FWCI
- 48.02
- 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)
- Leiden Repository (Leiden University) (submittedVersion, cc-by-nc-nd)
- 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, critically ill patients, intensive care unit, pulmonary embolism, deep vein thrombosis, ischemic stroke, myocardial infarction, systemic arterial embolism, thromboprophylaxis, long-term anticoagulation, therapeutic anticoagulation, all-cause mortality, competing risk analysis
- MeSH terms
- COVID-19, Acute Disease, Anticoagulants, Arterial Occlusive Diseases, Brain Ischemia, Embolism, Female, Follow-Up Studies, 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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