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
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12 nov 2022
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Categoría del artículo: Research Article
Publicado en línea: 12 nov 2022
Páginas: 249 - 258
Recibido: 17 mar 2022
Aceptado: 06 sept 2022
DOI: https://doi.org/10.2478/jccm-2022-0023
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© 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 Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Fig. 1
Characteristics of patients
| All patients N=310 | VTE N=41 | No VTE N=269 | P value | |
|---|---|---|---|---|
| Age (years), mean±SD | 60.1±15.1 | 58.8±15.7 | 60.3±15.1 | 0.56 |
| 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 (%) | ||||
| Hypertension | 173 (56.0) | 22 (53.7) | 151 (56.3) | 0.75 |
| Diabetes | 173 (56.0) | 22 (53.7) | 151 (56.3) | 0.75 |
| Congestive heart failure | 22 (7.1) | 1 (2.4) | 21 (7.8) | 0.21 |
| COPD | 10 (3.2) | 0 (0) | 10 (3.7) | 0.21 |
| Bronchial asthma | 18 (5.8) | 6 (14.6) | 12 (4.5) | 0.02 |
| Chronic kidney disease | 36 (11.7) | 3 (7.3) | 33 (12.3) | 0.35 |
| Hemodialysis | 11 (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 thrombophilia | 9 (2.9) | 1 (2.4) | 8 (3.0) | 1.0 |
| Prior anticoagulation | 20 (6.5) | 2 (4.9) | 18 (6.7) | 1.0 |
| GCS on admission, mean±SD | 12.3±4.5 | 11.5±4.9 | 12.5±4.4 | 0.21 |
| SOFA on admission, mean±SD | 6.1±3.9 | 6.5±3.9 | 6.0±3.9 | 0.52 |
| SOFA at day 7, mean±SD | 6.8±4.3 | 7.2±3.6 | 6.7±4.4 | 0.45 |
| 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 |
| Neutrophils | 7.94 (4.95, 11.55) | 7.82 (5.45, 11.70) | 7.95 (4.88, 11.54) | 0.51 |
| Lymphocytes | 0.93 (0.63, 1.41) | 0.89 (0.62, 1.32) | 0.94 (0.64, 1.42) | 0.54 |
| Admission hemoglobin (g/L), mean±SD | 129±24 | 132±25 | 128±24 | 0.37 |
| Admission platelets x 109/L, mean±SD | 279±120 | 291±137 | 278±117 | 0.51 |
| 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±SD | 2.6±2.4 | 3.1±3.2 | 2.5±2.3 | 0.31 |
| 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 ratio | 1.9±5.3 | 4.2±8.7 | 1.5±4.5 | 0.14 |
| Key interventions in the ICU before VTE | ||||
| Central venous catheter | 206 (66.5) | 33 (80.5) | 173 (64.3) | 0.04 |
| Internal jugular | 156 (50.3) | 26 (63.4) | 130 (48.3) | |
| Subclavian | 13 (4.2) | 3 (7.3) | 10 (3.7) | 0.20 |
| Femoral | 34 (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
| Variables | All patients N=310 | VTE N=41 | No VTE N=269 | P 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
| Variables | All patients N=310 | VTE N=41 | No VTE N=269 | P 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 patients | 10.0 (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 |