Abstract Number: PB0237
Meeting: ISTH 2021 Congress
Theme: COVID and Coagulation » COVID and Coagulation, Clinical
Background: COVID-19 pneumonia is associated with high rates of thromboembolic complications particularly in patients on intensive care unit (ICU). Optimal intensity of pharmacological thromboprophylaxis remains unclear.
Aims: To evaluate incidence of venous thromboembolism (VTE) and major bleeding in critically ill COVID-19 patients.
Methods: We included 92 consecutive patients admitted to one ICU of our hospital between October 2020 and March 2021. All patients required invasive mechanical ventilation. In 5 patients pulmonary embolism (PE) was confirmed on admission and they received a therapeutic dose of dalteparine. Therapeutic dalteparin or unfractionated heparin was used in some patients with a history of thromboembolism or renal failure. The majority of other patients were treated with a half-therapeutic dalteparin dose. Only 8 patients received prophylactic dalteparin in one patient thromboprophylaxis was omitted due to severe thrombocytopenia (Table 1). Compression ultrasonography of femoral, axillar and jugular veins was performed weekly until ICU discharge. CT angiography of the thorax was performed only if clinically indicated.
Results: We diagnosed 30 thromboembolic events; 1 arterial embolism and 29 VTE: 4 PE (4%), 24 (26%) catheter-related and 1 spontaneous venous thrombosis (VT). Two patients with catheter-related VT suffered segmental PE. The rates of major bleeding and mortality are shown in Table 1. Among patients with PE on admission no one suffered recurrent VTE or major bleeding, 1 died.
| All admitted patients N=92 |
Patients with VTE during hospitalization N=29 |
Patients without VTE during hospitalization N=58 |
|
| Age (years) | 67±13 | 67±11 | 68±12 |
| Male (%) | 67 (73) | 22 (76) | 41 (71) |
| BMI (kg/m2) | 29±5 | 29±4 | 30±6 |
| Active cancer (N) | 4 | 3 | 1 |
| VTE on admission | 5 | 0 | – |
| Heparins: | |||
| Dalteparin: half-therapeutic (%) Dalteparin/UH: therapeutic Dalteparin/UH: prophylactic Fondaparinux None |
68 (73,9) 14 (15,2) 8 (8,7) 1 (1,1) 1 (1,1) |
21 (72,4) 3 (11,4) 5 (17,2) – – |
47 (81,0) 7 (12,1) 3 (5,2) – 1 (1,7) |
| Major bleeding | 9 (9,8) | 5 (17,2) | 4 (6,9) |
| In-hospital mortality | 27 (29,3) | 10 (34,4) | 16 (27,5) |
| ICU length of stay (weeks) | 4±2 | 5±3 | 3±2 |
Characteristics of patients with venous thrombembolism (VTE) and without VTE during ICU stay. Results are shown as mean and standard deviation or as percentage.BMI – body mass index, UH-unfractionated heparin
Conclusions: Almost one-third of critically ill COVID-19 patients suffered VTE, despite using a half-therapeutic dose of dalteparin. Most of the events were catheter-related VT and in those patients risk of major bleeding increases after therapeutic anticoagulation with dalteparin. The mortality rate was similar between those who developed VTE and those who did not.
To cite this abstract in AMA style:
Mavri A, Lukić M, Mavrič M, Šoštarič N, Zupančič D. Thrombosis and Bleeding in Critically Ill COVID-19 Patients at Higher than Prophylactic Dose of Heparins [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/thrombosis-and-bleeding-in-critically-ill-covid-19-patients-at-higher-than-prophylactic-dose-of-heparins/. Accessed November 28, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/thrombosis-and-bleeding-in-critically-ill-covid-19-patients-at-higher-than-prophylactic-dose-of-heparins/