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ORIGINAL ARTICLE  VENOUS DISEASE Editor’s choice • Free accessfree

International Angiology 2022 February;41(1):1-8

DOI: 10.23736/S0392-9590.21.04704-0


lingua: Inglese

Mortality and bleeding complications of COVID-19 critically ill patients with venous thromboembolism

Daniel GIL-SALA 1, 2, Claudia RIERA 3, Marvin GARCÍA-REYES 1, 2 , Manuela RODRÍGUEZ 3, Carlos E. MARRERO 1, 2, Lucía MARTÍNEZ 3, Miquel GIL 3, Juan C. RUIZ-RODRÍGUEZ 4, Ricard FERRER 4, Miriam DE NADAL 5, Milagros A. SUITO-ALCÁNTARA 6, Secundino LLAGOSTERA 3, Sergi BELLMUNT-MONTOYA 1, 2

1 Department of Angiology and Vascular Surgery, Hospital Universitari Vall d’Hebron - HUVH, Barcelona, Spain; 2 Department of Surgery, Universitat Autònoma de Barcelona - UAB, Barcelona, Spain; 3 Department Angiology and Vascular Surgery, Hospital Universitari Germans Trias i Pujol - HUGTiP, Badalona, Spain; 4 Department of Intensive Care, Hospital Universitari Vall d’Hebron - HUVH, Barcelona, Spain; 5 Unit of Anesthesiology, Hospital Universitari Vall d’Hebron - HUVH, Barcelona, Spain; 6 Unit of Hemostasis, Department of Hematology, Hospital Universitari Vall d’Hebron - HUVH, Barcelona, Spain

BACKGROUND: Venous thromboembolism (VTE) disease in COVID-19 patients is a remarkable issue, especially its relationship with bleeding events and mortality. The objective of this study was to describe the outcomes of critically ill patients with COVID-19, hospitalized in the Intensive Care Unit (ICU), in relationship with VTE during their stay.
METHODS: This is a prospective cohort study of critically ill COVID-19 patients in two hospitals that underwent a venous ultrasound at the beginning of follow-up of both lower limbs in April 2020. In case of clinical suspicion of new VTE during the 30-day follow-up, additional ultrasound or thoracic CT were performed. Global VTE frequency, major bleeding events and survival were collected, and their predictors were studied.
RESULTS: We included 230 patients. After 30 days of follow-up, there were 95 VTE events in 86 patients (37.4%). Thirteen patients (5.7%) developed major bleeding complications and 42 patients (18.3%) died. None of the comorbidities or previous treatments were related with bleeding events. D-Dimer at admission was significantly related with VTE development and mortality. Independent predictors of mortality in the regression model were older age (>66 years), D-Dimer at admission (>1.500 ng/mL) and low lymphocyte count (<0.45×109/L) with an AUC in the ROC curve of 0.81 (95% CI: 0.73-0.89). Patients presenting these three conditions presented a mortality of 100% in the predictive model.
CONCLUSIONS: VTE frequency in ICU COVID-19 patients is high and risk of major bleeding is low. Comorbidities and laboratory parameters of admission in these patients can be a useful tool to predict mortality.

KEY WORDS: SARS-CoV-2; COVID-19; Venous thromboembolism; Venous thrombosis; Mortality; Hemorrhage

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