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International Angiology 2021 Nov 09

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 Carlos RUIZ-RODRÍGUEZ 4, Ricard FERRER 4, Miriam DE NADAL 5, Milagros A. SUITO-ALCÁNTARA 6, Secundino LLAGOSTERA 3, Sergi BELLMUNT 1, 2

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


BACKGROUND: 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 ICU in relationship with VTE during their stay.
METHODS: 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. When 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%). 13 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 an older age (>66 years), D-dimer at admission (>1 500ng/mL) and low lymphocyte count (<0,45x109/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 a 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 infection; COVID19; Venous thromboembolism; Deep venous thrombosis; Mortality; Bleeding

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