Compared with patients with coronavirus disease 2019 (COVID-19) who were not admitted to intensive care unit (ICU), ICU patients with COVID-19 had distinct phenotypic characteristics, including increased symptomatic venous thromboembolism (VTE), according to study results published in Chest.

Investigators conducted a retrospective analysis of patients with COVID-19 who were seen at Brigham and Women’s Hospital in Boston, Massachusetts. A total of 102 patients who had been treated in the ICU were evaluated, and outcomes were compared to those of 108 ward patients. Infection with severe acute respiratory syndrome coronavirus 2 was determined from nasopharyngeal samples assessed with reverse transcription polymerase chain reaction.

VTE prophylaxis had been advised for each patient, and multiple hematologic parameters were evaluated regularly throughout hospitalizations. The primary outcome was symptomatic VTE, as either deep vein thrombosis (DVT) in a lower extremity or as a pulmonary embolism (PE).

Median study follow-up was 7 days (interquartile range [IQR], 4-14). Anticoagulation therapy was administered to nearly all patients (90.5%) upon admission, with prophylactic anticoagulation for 80.5% of patients. Median patient stays were 15.00 days in the ICU group and 5.00 days in the ward group (P <.001).


Continue Reading

Patients in the ICU group who received anticoagulation therapy had a 14-day 9.3% (95% CI, 4.7%-17.8%) cumulative incidence of radiologically confirmed VTE. Among patients in the ICU, there were 7 DVTs, 2 confirmed PEs, and 2 suspected PEs. In contrast, no VTE events occurred among the ward patients (P =.006).

Occurrences of prior VTEs were similar between the patient groups, with 3.9% of the ICU group and 4.6% of the ward group. Laboratory values of fibrinogen, prothrombin time, activated partial thromboplastin time, D-dimer at admission and at its maximum, lactate dehydrogenase, ferritin, C-reactive protein, and lactate were all significantly higher among ICU patients than in ward patients.

From ICU admission to a diagnosis of VTE, there was a median time of 6 days (IQR, 5-7). The researchers interpreted this to mean that ICU admission was likely not a result of VTE in these patients.

Acute respiratory distress syndrome (ARDS) occurred among 84.3% of patients in the ICU group, and it was reported in no patients in the ward group (P <.001). Overall, deaths occurred in 27.5% of the patients in the ICU group and in 6.5% of patients in the ward group (P <.001).

“In summary, ICU patients exhibited a distinct phenotype characterized by elevated inflammatory markers, ARDS, and a significant increase in the cumulative incidence of symptomatic VTE compared to those not requiring ICU care, suggesting that standard VTE prophylaxis is insufficient in these patients,” wrote the researchers in their report.

Disclosures: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.

Reference

Moll M, Zon RL, Sylvester KW, et al. Venous thromboembolism in COVID-19 ICU patients [published online July 22, 2020]. Chest. doi: 10.1016/j.chest.2020.07.031