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Prevalence and Risk Factors of Venous Thromboembolism in Critically Ill Patients with Severe COVID-19 and the Association between the Dose of Anticoagulants and Outcomes Cover

Prevalence and Risk Factors of Venous Thromboembolism in Critically Ill Patients with Severe COVID-19 and the Association between the Dose of Anticoagulants and Outcomes

Open Access
|Nov 2022

Figures & Tables

Fig. 1

Receiver operating characteristic (ROC) curve for admission D-dimer and D-dimer/fibrinogen ratio for the diagnosis of clinically suspected and confirmed venous thromboembolism

Characteristics of patients

All patients N=310VTE N=41No VTE N=269P value
Age (years), mean±SD60.1±15.158.8±15.760.3±15.10.56
Male gender, N (%)233 (75.2)30 (73.2)203 (75.5)0.75

Body mass index* (kg/m2), median (Q1, Q3)28.9 (25.0, 34.1)27.1 (24.4, 33.3)29.1 (25.1, 34.2)0.32
No obesity < 30 kg/m2, N (%)169 (55.6)25 (62.5)144 (54.5)
Obesity 30-39.9 kg/m2, N (%)110 (36.2)10 (25.0)100 (37.9)0.22
Obesity ≥ 40 kg/m2, N (%)25 (8.2)5 (12.5)20 (7.6)

Comorbid conditions, N (%)
Hypertension173 (56.0)22 (53.7)151 (56.3)0.75
Diabetes173 (56.0)22 (53.7)151 (56.3)0.75
Congestive heart failure22 (7.1)1 (2.4)21 (7.8)0.21
COPD10 (3.2)0 (0)10 (3.7)0.21
Bronchial asthma18 (5.8)6 (14.6)12 (4.5)0.02
Chronic kidney disease36 (11.7)3 (7.3)33 (12.3)0.35
Hemodialysis11 (3.6)11 (3.6)9 (3.4)0.63
Previous VTE, N (%)11 (3.5)1 (2.4)10 (3.7)1.0
History of thrombophilia9 (2.9)1 (2.4)8 (3.0)1.0
Prior anticoagulation20 (6.5)2 (4.9)18 (6.7)1.0
GCS on admission, mean±SD12.3±4.511.5±4.912.5±4.40.21
SOFA on admission, mean±SD6.1±3.96.5±3.96.0±3.90.52
SOFA at day 7, mean±SD6.8±4.37.2±3.66.7±4.40.45

Pertinent laboratory findings on admission
Creatinine (μmol/L), median (Q1, Q3)93.0 (73.0, 144.5)103.0 (71.5, 139.5)93.0 (73.0, 146.8)0.97
WBC x 109/L, median (Q1, Q3)9.82 (6.65, 13.80)10.80 (7.37, 16.10)9.81 (6.51, 13.75)0.22
Neutrophils7.94 (4.95, 11.55)7.82 (5.45, 11.70)7.95 (4.88, 11.54)0.51
Lymphocytes0.93 (0.63, 1.41)0.89 (0.62, 1.32)0.94 (0.64, 1.42)0.54
Admission hemoglobin (g/L), mean±SD129±24132±25128±240.37
Admission platelets x 109/L, mean±SD279±120291±137278±1170.51
PTT in seconds, median (Q1, Q3)29.1 (26.5, 32.6)28.5 (26.0, 32.8)29.3 (26.5, 32.6)0.61
INR, median (Q1, Q3)1.10 (1.04, 1.18)1.12 (1.06, 1.30)1.10 (1.03, 1.18)0.12
Lactate (mmol/L), mean±SD2.6±2.43.1±3.22.5±2.30.31
Lactate dehydrogenase (U/L), median (Q1, Q3)553.0 (430.0, 749.0)615.0 (412.0, 837.0)544.5 (437.5, 731.5)0.23
Fibrinogen (g/L), median (Q1, Q3)5.22 (3.81, 6.92)4.05 (2.62, 6.07)5.49 (3.97, 7.06)0.003
D-Dimer (mg/L), median (Q1, Q3)1.70 (0.80, 4.05)3.86 (1.28, 14.43)1.47 (0.77, 3.72)0.001
D-Dimer/fibrinogen ratio1.9±5.34.2±8.71.5±4.50.14

Key interventions in the ICU before VTE
Central venous catheter206 (66.5)33 (80.5)173 (64.3)0.04
Internal jugular156 (50.3)26 (63.4)130 (48.3)
Subclavian13 (4.2)3 (7.3)10 (3.7)0.20
Femoral34 (11.0)4 (9.8)30 (11.2)
Vasopressor use, N (%)138 (44.7)27 (67.5)111 (41.3)0.002
Invasive mechanical ventilation, N (%)208 (67.1)33 (80.5)175 (65.1)0.05
PaO2/FiO2 ratio before intubation, median (Q1, Q3)92.5 (66.5, 164.3)90.0 (78.7, 214.5)95.8 (63.0, 153.0)0.17
Renal replacement therapy, N (%)67 (21.6)11 (26.8)56 (20.8)0.38

VTE prophylaxis practices

VariablesAll patients N=310VTE N=41No VTE N=269P value
No anticoagulant prophylaxis, N (%)
9 (2.9)
3 (7.3)
6 (2.2)
0.10
UFH, N (%)115 (37.1)15 (36.6)100 (37.2)0.94
Standard dose (5000 U 12 hrly)53 (46.1)*8 (53.3)*45 (45.0)*0.59
standard dose (5000 U 8 hrly)53 (46.1)*4 (26.7)*49 (49.0)*0.16
Intravenous infusion
9 (7.8)*
3 (20.0)*
6 (6.0)*
0.09
LMWH, N (%)185 (59.7)23 (56.1)162 (60.2)0.62
standard dose*104 (56.2)*11 (47.8)*93 (57.4)*0.50
Intermediate dose*¶57 (30.8)*3 (13.0)*54 (33.3)*0.055
Therapeutic dose*24 (13.0)*9 (39.1)*15 (9.3)*<0.001

Outcomes of patients in the cohort

VariablesAll patients N=310VTE N=41No VTE N=269P value
Major bleeding, N (%)
42 (13.5)
8 (19.5)
34 (12.6)
0.23
Tracheostomy, N (%)
29 (9.4)
9 (22.0)
20 (7.4)
0.003
Duration of invasive MV (days), median (Q1, Q3)
12.0 (7.0, 20.0)
12.00 (7.0, 30.5)
12.0 (7.0, 19.0)
0.36
ICU LOS (days), median (Q1, Q3)
All patients10.0 (5.0, 18.0)13.0 (7.0, 25.5)10.0 (4.5, 17.0)0.04
Patients who received invasive MV
14.0 (9.0, 22.0)
16.0 (9.5, 33.0)
14.0 (9.0, 21.0)
0.39
Hospital LOS (days), median (Q1, Q3)
19.0 (12.0, 29.0)
30.0 (19.0, 42.0)
17.0 (12.0, 27.0)
<0.001
ICU Mortality, N (%)123 (39.8)12 (29.3)111 (41.4)0.14
Hospital mortality, N (%)147 (47.4)13 (31.7)134 (49.8)0.03
DOI: https://doi.org/10.2478/jccm-2022-0023 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
Language: English
Page range: 249 - 258
Submitted on: Mar 17, 2022
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Accepted on: Sep 6, 2022
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Published on: Nov 12, 2022
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2022 Hasan M. Al-Dorzi, Muhannad Q. Alqirnas, Mohamed M. Hegazy, Abdullah S. Alghamdi, Mohammed T. Alotaibi, Mohammed T. Albogami, Mohammed M. Alhafi, Salem Alwadani, Ashraf Elsharkawi, Yaseen M. Arabi, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.