According to a new study published in Critical Care, critically ill patients with COVID-19 have high rates of thromboembolic complications. Additionally, the incidence of bleeding may be higher than previously reported in such patients.
The data come from a multicentre, retrospective observational study involving 187 adult patients with COVID-19 admitted to intensive care units (ICUs) of four tertiary hospitals in the UK.
43.3 per cent of patients experienced one or more clinically relevant thrombotic complication, primarily pulmonary embolism (22.5%). 13.3 per cent of patients reported arterial embolic complications. Patients with thrombotic complications had a longer length of stay in the ICU compared with those without complications (17 vs 12 days; P=.003). 8 per cent of patients had haemorrhagic complications, of which 4.8 per cent were cases of major bleeding.
Patients with thrombotic complications had significantly higher values of D-dimer (P<.001), troponin T (P=.008), troponin I (P<.001), white blood cell count (P=.024) and ferritin (P=.008) at admission compared with those without complications. Thromboelastography was performed in 20 patients, but it lacked discriminatory value.
"Our multicentre study supports previous reports of a high incidence of thromboembolic complications in ICU patients with COVID-19, despite the initiation of thromboprophylaxis," the authors say. They call for further randomised trials to understand the risk-benefit ratio of anticoagulation strategies in detail.
