High incidence of venous thromboembolic events in anticoagulated severe COVID‐19 patients
Background Coagulopathy is a common abnormality in patients with COVID‐19. However, the exact incidence of venous thromboembolic event is unknown in anticoagulated, severe COVID‐19 patients. Objectives Systematic assessment of venous thromboembolism (VTE) using complete duplex ultrasound (CDU) in an...
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| Published in | Journal of thrombosis and haemostasis Vol. 18; no. 7; pp. 1743 - 1746 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
Elsevier Limited
01.07.2020
John Wiley and Sons Inc |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1538-7933 1538-7836 1538-7836 |
| DOI | 10.1111/jth.14869 |
Cover
| Abstract | Background
Coagulopathy is a common abnormality in patients with COVID‐19. However, the exact incidence of venous thromboembolic event is unknown in anticoagulated, severe COVID‐19 patients.
Objectives
Systematic assessment of venous thromboembolism (VTE) using complete duplex ultrasound (CDU) in anticoagulated COVID‐19 patients.
Patients and methods
We performed a retrospective study in 2 French intensive care units (ICU) where CDU is performed as a standard of care. A CDU from thigh to ankle at selected sites with Doppler waveforms and images was performed early during ICU stay in patients admitted with COVID‐19. Anticoagulation dose was left to the discretion of the treating physician based on the individual risk of thrombosis. Patients were classified as treated with prophylactic anticoagulation or therapeutic anticoagulation. Pulmonary embolism was systematically searched in patients with persistent hypoxemia or secondary deterioration.
Results
From March 19 to April 11, 2020, 26 consecutive patients with severe COVID‐19 were screened for VTE. Eight patients (31%) were treated with prophylactic anticoagulation, whereas 18 patients (69%) were treated with therapeutic anticoagulation. The overall rate of VTE in patients was 69%. The proportion of VTE was significantly higher in patients treated with prophylactic anticoagulation when compared with the other group (100% vs 56%, respectively, P = .03). Surprisingly, we found a high rate of thromboembolic events in COVID‐19 patients treated with therapeutic anticoagulation, with 56% of VTE and 6 pulmonary embolisms.
Conclusion
Our results suggest considering both systematic screening of VTE and early therapeutic anticoagulation in severe ICU COVID‐19 patients. |
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| AbstractList | Background
Coagulopathy is a common abnormality in patients with COVID‐19. However, the exact incidence of venous thromboembolic event is unknown in anticoagulated, severe COVID‐19 patients.
Objectives
Systematic assessment of venous thromboembolism (VTE) using complete duplex ultrasound (CDU) in anticoagulated COVID‐19 patients.
Patients and methods
We performed a retrospective study in 2 French intensive care units (ICU) where CDU is performed as a standard of care. A CDU from thigh to ankle at selected sites with Doppler waveforms and images was performed early during ICU stay in patients admitted with COVID‐19. Anticoagulation dose was left to the discretion of the treating physician based on the individual risk of thrombosis. Patients were classified as treated with prophylactic anticoagulation or therapeutic anticoagulation. Pulmonary embolism was systematically searched in patients with persistent hypoxemia or secondary deterioration.
Results
From March 19 to April 11, 2020, 26 consecutive patients with severe COVID‐19 were screened for VTE. Eight patients (31%) were treated with prophylactic anticoagulation, whereas 18 patients (69%) were treated with therapeutic anticoagulation. The overall rate of VTE in patients was 69%. The proportion of VTE was significantly higher in patients treated with prophylactic anticoagulation when compared with the other group (100% vs 56%, respectively, P = .03). Surprisingly, we found a high rate of thromboembolic events in COVID‐19 patients treated with therapeutic anticoagulation, with 56% of VTE and 6 pulmonary embolisms.
Conclusion
Our results suggest considering both systematic screening of VTE and early therapeutic anticoagulation in severe ICU COVID‐19 patients. Coagulopathy is a common abnormality in patients with COVID-19. However, the exact incidence of venous thromboembolic event is unknown in anticoagulated, severe COVID-19 patients.BACKGROUNDCoagulopathy is a common abnormality in patients with COVID-19. However, the exact incidence of venous thromboembolic event is unknown in anticoagulated, severe COVID-19 patients.Systematic assessment of venous thromboembolism (VTE) using complete duplex ultrasound (CDU) in anticoagulated COVID-19 patients.OBJECTIVESSystematic assessment of venous thromboembolism (VTE) using complete duplex ultrasound (CDU) in anticoagulated COVID-19 patients.We performed a retrospective study in 2 French intensive care units (ICU) where CDU is performed as a standard of care. A CDU from thigh to ankle at selected sites with Doppler waveforms and images was performed early during ICU stay in patients admitted with COVID-19. Anticoagulation dose was left to the discretion of the treating physician based on the individual risk of thrombosis. Patients were classified as treated with prophylactic anticoagulation or therapeutic anticoagulation. Pulmonary embolism was systematically searched in patients with persistent hypoxemia or secondary deterioration.PATIENTS AND METHODSWe performed a retrospective study in 2 French intensive care units (ICU) where CDU is performed as a standard of care. A CDU from thigh to ankle at selected sites with Doppler waveforms and images was performed early during ICU stay in patients admitted with COVID-19. Anticoagulation dose was left to the discretion of the treating physician based on the individual risk of thrombosis. Patients were classified as treated with prophylactic anticoagulation or therapeutic anticoagulation. Pulmonary embolism was systematically searched in patients with persistent hypoxemia or secondary deterioration.From March 19 to April 11, 2020, 26 consecutive patients with severe COVID-19 were screened for VTE. Eight patients (31%) were treated with prophylactic anticoagulation, whereas 18 patients (69%) were treated with therapeutic anticoagulation. The overall rate of VTE in patients was 69%. The proportion of VTE was significantly higher in patients treated with prophylactic anticoagulation when compared with the other group (100% vs 56%, respectively, P = .03). Surprisingly, we found a high rate of thromboembolic events in COVID-19 patients treated with therapeutic anticoagulation, with 56% of VTE and 6 pulmonary embolisms.RESULTSFrom March 19 to April 11, 2020, 26 consecutive patients with severe COVID-19 were screened for VTE. Eight patients (31%) were treated with prophylactic anticoagulation, whereas 18 patients (69%) were treated with therapeutic anticoagulation. The overall rate of VTE in patients was 69%. The proportion of VTE was significantly higher in patients treated with prophylactic anticoagulation when compared with the other group (100% vs 56%, respectively, P = .03). Surprisingly, we found a high rate of thromboembolic events in COVID-19 patients treated with therapeutic anticoagulation, with 56% of VTE and 6 pulmonary embolisms.Our results suggest considering both systematic screening of VTE and early therapeutic anticoagulation in severe ICU COVID-19 patients.CONCLUSIONOur results suggest considering both systematic screening of VTE and early therapeutic anticoagulation in severe ICU COVID-19 patients. Coagulopathy is a common abnormality in patients with COVID-19. However, the exact incidence of venous thromboembolic event is unknown in anticoagulated, severe COVID-19 patients. Systematic assessment of venous thromboembolism (VTE) using complete duplex ultrasound (CDU) in anticoagulated COVID-19 patients. We performed a retrospective study in 2 French intensive care units (ICU) where CDU is performed as a standard of care. A CDU from thigh to ankle at selected sites with Doppler waveforms and images was performed early during ICU stay in patients admitted with COVID-19. Anticoagulation dose was left to the discretion of the treating physician based on the individual risk of thrombosis. Patients were classified as treated with prophylactic anticoagulation or therapeutic anticoagulation. Pulmonary embolism was systematically searched in patients with persistent hypoxemia or secondary deterioration. From March 19 to April 11, 2020, 26 consecutive patients with severe COVID-19 were screened for VTE. Eight patients (31%) were treated with prophylactic anticoagulation, whereas 18 patients (69%) were treated with therapeutic anticoagulation. The overall rate of VTE in patients was 69%. The proportion of VTE was significantly higher in patients treated with prophylactic anticoagulation when compared with the other group (100% vs 56%, respectively, P = .03). Surprisingly, we found a high rate of thromboembolic events in COVID-19 patients treated with therapeutic anticoagulation, with 56% of VTE and 6 pulmonary embolisms. Our results suggest considering both systematic screening of VTE and early therapeutic anticoagulation in severe ICU COVID-19 patients. BackgroundCoagulopathy is a common abnormality in patients with COVID‐19. However, the exact incidence of venous thromboembolic event is unknown in anticoagulated, severe COVID‐19 patients.ObjectivesSystematic assessment of venous thromboembolism (VTE) using complete duplex ultrasound (CDU) in anticoagulated COVID‐19 patients.Patients and methodsWe performed a retrospective study in 2 French intensive care units (ICU) where CDU is performed as a standard of care. A CDU from thigh to ankle at selected sites with Doppler waveforms and images was performed early during ICU stay in patients admitted with COVID‐19. Anticoagulation dose was left to the discretion of the treating physician based on the individual risk of thrombosis. Patients were classified as treated with prophylactic anticoagulation or therapeutic anticoagulation. Pulmonary embolism was systematically searched in patients with persistent hypoxemia or secondary deterioration.ResultsFrom March 19 to April 11, 2020, 26 consecutive patients with severe COVID‐19 were screened for VTE. Eight patients (31%) were treated with prophylactic anticoagulation, whereas 18 patients (69%) were treated with therapeutic anticoagulation. The overall rate of VTE in patients was 69%. The proportion of VTE was significantly higher in patients treated with prophylactic anticoagulation when compared with the other group (100% vs 56%, respectively, P = .03). Surprisingly, we found a high rate of thromboembolic events in COVID‐19 patients treated with therapeutic anticoagulation, with 56% of VTE and 6 pulmonary embolisms.ConclusionOur results suggest considering both systematic screening of VTE and early therapeutic anticoagulation in severe ICU COVID‐19 patients. |
| Author | Chochois, Camille Auvray, Malika Leclerc, Maxime Monsallier, Jean‐Michel Merouani, Karim Llitjos, Jean‐François Ramakers, Michel |
| AuthorAffiliation | 2 Service de Réanimation Soins Continus Centre Hospitalier Mémorial France Etats‐Unis Saint‐Lô France 1 Institut Cochin 3i Department, Team “Pulmonary & Systemic Immune Responses During Acute and Chronic Bacterial Infections” Paris France 3 Service de Réanimation Centre Hospitalier Intercommunal Alençon Mamers Alençon France |
| AuthorAffiliation_xml | – name: 2 Service de Réanimation Soins Continus Centre Hospitalier Mémorial France Etats‐Unis Saint‐Lô France – name: 1 Institut Cochin 3i Department, Team “Pulmonary & Systemic Immune Responses During Acute and Chronic Bacterial Infections” Paris France – name: 3 Service de Réanimation Centre Hospitalier Intercommunal Alençon Mamers Alençon France |
| Author_xml | – sequence: 1 givenname: Jean‐François surname: Llitjos fullname: Llitjos, Jean‐François email: jean-francois.llitjos@inserm.fr organization: 3i Department, Team “Pulmonary & Systemic Immune Responses During Acute and Chronic Bacterial Infections” – sequence: 2 givenname: Maxime surname: Leclerc fullname: Leclerc, Maxime organization: Centre Hospitalier Mémorial France Etats‐Unis – sequence: 3 givenname: Camille surname: Chochois fullname: Chochois, Camille organization: Centre Hospitalier Mémorial France Etats‐Unis – sequence: 4 givenname: Jean‐Michel surname: Monsallier fullname: Monsallier, Jean‐Michel organization: Centre Hospitalier Intercommunal Alençon Mamers – sequence: 5 givenname: Michel surname: Ramakers fullname: Ramakers, Michel organization: Centre Hospitalier Mémorial France Etats‐Unis – sequence: 6 givenname: Malika surname: Auvray fullname: Auvray, Malika organization: Centre Hospitalier Mémorial France Etats‐Unis – sequence: 7 givenname: Karim surname: Merouani fullname: Merouani, Karim organization: Centre Hospitalier Intercommunal Alençon Mamers |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32320517$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1111/jth.14810 10.1001/jama.2020.4683 10.1111/jth.14830 10.1001/jama.2020.1585 10.1111/jth.14817 |
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| License | 2020 International Society on Thrombosis and Haemostasis. This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency. |
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| References | 2020; 323 2020 2020; 18 Klok (10.1111/jth.14869_bb0030) 2020 Tang (10.1111/jth.14869_bb0020) 2020; 18 Cui (10.1111/jth.14869_bb0035) 2020; 18 Onder (10.1111/jth.14869_bb0015) 2020 Thachil (10.1111/jth.14869_bb0025) 2020; 18 Wang (10.1111/jth.14869_bb0010) 2020; 323 32795720 - Thromb Res. 2020 Nov;195:226-227 |
| References_xml | – year: 2020 article-title: Incidence of thrombotic complications in critically ill ICU patients with COVID‐19 publication-title: Thromb Res – volume: 323 start-page: 1061 issue: 11 year: 2020 article-title: Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus‐infected pneumonia in Wuhan, China publication-title: JAMA – year: 2020 article-title: Case‐fatality rate and characteristics of patients dying in relation to COVID‐19 in Italy publication-title: JAMA – volume: 18 start-page: 1421 year: 2020 end-page: 1424 article-title: Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia publication-title: J Thromb Haemost – volume: 18 start-page: 1094 issue: 5 year: 2020 end-page: 1099 article-title: Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy publication-title: J Thromb Haemost – volume: 18 start-page: 1023 issue: 5 year: 2020 end-page: 1026 article-title: ISTH interim guidance on recognition and management of coagulopathy in COVID‐19 publication-title: J Thromb Haemost – volume: 18 start-page: 1023 issue: 5 year: 2020 ident: 10.1111/jth.14869_bb0025 article-title: ISTH interim guidance on recognition and management of coagulopathy in COVID‐19 publication-title: J Thromb Haemost doi: 10.1111/jth.14810 – year: 2020 ident: 10.1111/jth.14869_bb0015 article-title: Case‐fatality rate and characteristics of patients dying in relation to COVID‐19 in Italy publication-title: JAMA doi: 10.1001/jama.2020.4683 – volume: 18 start-page: 1421 year: 2020 ident: 10.1111/jth.14869_bb0035 article-title: Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia publication-title: J Thromb Haemost doi: 10.1111/jth.14830 – volume: 323 start-page: 1061 issue: 11 year: 2020 ident: 10.1111/jth.14869_bb0010 article-title: Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus‐infected pneumonia in Wuhan, China publication-title: JAMA doi: 10.1001/jama.2020.1585 – volume: 18 start-page: 1094 issue: 5 year: 2020 ident: 10.1111/jth.14869_bb0020 article-title: Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy publication-title: J Thromb Haemost doi: 10.1111/jth.14817 – year: 2020 ident: 10.1111/jth.14869_bb0030 article-title: Incidence of thrombotic complications in critically ill ICU patients with COVID‐19 publication-title: Thromb Res – reference: 32795720 - Thromb Res. 2020 Nov;195:226-227 |
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Coagulopathy is a common abnormality in patients with COVID‐19. However, the exact incidence of venous thromboembolic event is unknown in... Coagulopathy is a common abnormality in patients with COVID-19. However, the exact incidence of venous thromboembolic event is unknown in anticoagulated,... BackgroundCoagulopathy is a common abnormality in patients with COVID‐19. However, the exact incidence of venous thromboembolic event is unknown in... |
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| SubjectTerms | Aged Ankle Anticoagulants - therapeutic use anticoagulation Betacoronavirus - pathogenicity Blood Coagulation - drug effects Brief Report Coronavirus Infections - blood Coronavirus Infections - drug therapy Coronavirus Infections - epidemiology Coronavirus Infections - virology COVID-19 critical care Embolism Female France - epidemiology Health risk assessment Host-Parasite Interactions Humans Hypoxemia Incidence Intensive care units Male Middle Aged Pandemics Pneumonia, Viral - blood Pneumonia, Viral - drug therapy Pneumonia, Viral - epidemiology Pneumonia, Viral - virology pulmonary embolism Pulmonary Embolism - blood Pulmonary Embolism - epidemiology Pulmonary Embolism - prevention & control Pulmonary Embolism - virology Pulmonary embolisms Retrospective Studies Risk Factors SARS-CoV-2 Severity of Illness Index Thromboembolism THROMBOSIS Treatment Outcome Ultrasound venous thromboembolism Venous Thromboembolism - blood Venous Thromboembolism - epidemiology Venous Thromboembolism - prevention & control Venous Thromboembolism - virology Venous Thrombosis - blood Venous Thrombosis - epidemiology Venous Thrombosis - prevention & control Venous Thrombosis - virology |
| Title | High incidence of venous thromboembolic events in anticoagulated severe COVID‐19 patients |
| URI | https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fjth.14869 https://www.ncbi.nlm.nih.gov/pubmed/32320517 https://www.proquest.com/docview/2419749036 https://www.proquest.com/docview/2394266889 https://pubmed.ncbi.nlm.nih.gov/PMC7264774 |
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