New Insights in the Occurrence of Venous Thromboembolism in Critically Ill Patients with COVID-19—A Large Postmortem and Clinical Analysis
Critically ill COVID-19 patients are at high risk for venous thromboembolism (VTE), namely deep vein thrombosis (DVT) and/or pulmonary embolism (PE), and death. The optimal anticoagulation strategy in critically ill patients with COVID-19 remains unknown. This study investigated the ante mortem inci...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-04-01
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| Series: | Viruses |
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| Online Access: | https://www.mdpi.com/1999-4915/14/4/811 |
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| author | Fabian Heinrich Kevin Roedl Dominik Jarczak Hanna-Lisa Goebels Axel Heinemann Ulrich Schäfer Frank Ludwig Martin Bachmann Berthold Bein Christian Friedrich Weber Karsten Sydow Marc Bota Hans-Richard Paschen Andreas de Weerth Carsten Veit Oliver Detsch Philipp-Alexander Brand Stefan Kluge Benjamin Ondruschka Dominic Wichmann |
| author_facet | Fabian Heinrich Kevin Roedl Dominik Jarczak Hanna-Lisa Goebels Axel Heinemann Ulrich Schäfer Frank Ludwig Martin Bachmann Berthold Bein Christian Friedrich Weber Karsten Sydow Marc Bota Hans-Richard Paschen Andreas de Weerth Carsten Veit Oliver Detsch Philipp-Alexander Brand Stefan Kluge Benjamin Ondruschka Dominic Wichmann |
| author_sort | Fabian Heinrich |
| collection | DOAJ |
| description | Critically ill COVID-19 patients are at high risk for venous thromboembolism (VTE), namely deep vein thrombosis (DVT) and/or pulmonary embolism (PE), and death. The optimal anticoagulation strategy in critically ill patients with COVID-19 remains unknown. This study investigated the ante mortem incidence as well as postmortem prevalence of VTE, the factors predictive of VTE, and the impact of changed anticoagulation practice on patient survival. We conducted a consecutive retrospective analysis of postmortem COVID-19 (<i>n</i> = 64) and non-COVID-19 (<i>n</i> = 67) patients, as well as ante mortem COVID-19 (<i>n</i> = 170) patients admitted to the University Medical Center Hamburg-Eppendorf (Hamburg, Germany). Baseline patient characteristics, parameters related to the intensive care unit (ICU) stay, and the clinical and autoptic presence of VTE were evaluated and statistically compared between groups. The occurrence of VTE in critically ill COVID-19 patients is confirmed in both ante mortem (17%) and postmortem (38%) cohorts. Accordingly, comparing the postmortem prevalence of VTE between age- and sex-matched COVID-19 (43%) and non-COVID-19 (0%) cohorts, we found the statistically significant increased prevalence of VTE in critically ill COVID-19 cohorts (<i>p</i> = 0.001). A change in anticoagulation practice was associated with the statistically significant prolongation of survival time (HR: 2.55, [95% CI 1.41–4.61], <i>p</i> = 0.01) and a reduction in VTE occurrence (54% vs. 25%; <i>p</i> = 0.02). In summary, in the autopsy as well as clinical cohort of critically ill patients with COVID-19, we found that VTE was a frequent finding. A change in anticoagulation practice was associated with a statistically significantly prolonged survival time. |
| first_indexed | 2024-03-09T04:08:10Z |
| format | Article |
| id | doaj.art-e762d869739548e48c47fb76db2ae35f |
| institution | Directory Open Access Journal |
| issn | 1999-4915 |
| language | English |
| last_indexed | 2024-03-09T04:08:10Z |
| publishDate | 2022-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Viruses |
| spelling | doaj.art-e762d869739548e48c47fb76db2ae35f2023-12-03T14:04:35ZengMDPI AGViruses1999-49152022-04-0114481110.3390/v14040811New Insights in the Occurrence of Venous Thromboembolism in Critically Ill Patients with COVID-19—A Large Postmortem and Clinical AnalysisFabian Heinrich0Kevin Roedl1Dominik Jarczak2Hanna-Lisa Goebels3Axel Heinemann4Ulrich Schäfer5Frank Ludwig6Martin Bachmann7Berthold Bein8Christian Friedrich Weber9Karsten Sydow10Marc Bota11Hans-Richard Paschen12Andreas de Weerth13Carsten Veit14Oliver Detsch15Philipp-Alexander Brand16Stefan Kluge17Benjamin Ondruschka18Dominic Wichmann19Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, GermanyDepartment of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, GermanyDepartment of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, GermanyInstitute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, GermanyInstitute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, GermanyDepartment of Cardiology, Angiology and Intensive Care Medicine, Marien Hospital, 22087 Hamburg, GermanyDepartment of Pneumonology and Intensive Care Medicine, Weaning Center, Asklepios Hospital Barmbek, 22307 Hamburg, GermanyDepartment of Intensive Care and Respiratory Medicine, Clinic for Airway, Thorax and Respiratory Medicine, Asklepios Hospital Harburg, 21075 Hamburg, GermanyDepartment of Anesthesiology, Intensive Care, Emergency Medicine and Pain Medicine, Asklepios Hospital St. Georg, 20099 Hamburg, GermanyDepartment of Anesthesiology, Intensive Care and Emergency Medicine, Asklepios Hospital Wandsbek, 22043 Hamburg, GermanyDepartment of Cardiology, Albertinen Hospital, 22457 Hamburg, GermanyDepartment of Internal Medicine, Bethesda Hospital Bergedorf, 21029 Hamburg, GermanyDepartment for Anesthesiology and Intensive Care Medicine, Amalie Sieveking Hospital, 22359 Hamburg, GermanyDepartment of Internal Medicine, Agaplesion Diakonie Hospital Hamburg, 20259 Hamburg, GermanyDepartment of Interdisciplinary Intensive Care Medicine, Bundeswehr Hospital, 22049 Hamburg, GermanyDepartment of Anesthesiology, Intensive Care, Emergency Medicine and Pain Medicine, Asklepios Hospital Nord, 22417 Hamburg, GermanyDepartment of Anesthesiology and Intensive Care Medicine, Helios Mariahilf Hospital, 21075 Hamburg, GermanyDepartment of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, GermanyInstitute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, GermanyDepartment of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, GermanyCritically ill COVID-19 patients are at high risk for venous thromboembolism (VTE), namely deep vein thrombosis (DVT) and/or pulmonary embolism (PE), and death. The optimal anticoagulation strategy in critically ill patients with COVID-19 remains unknown. This study investigated the ante mortem incidence as well as postmortem prevalence of VTE, the factors predictive of VTE, and the impact of changed anticoagulation practice on patient survival. We conducted a consecutive retrospective analysis of postmortem COVID-19 (<i>n</i> = 64) and non-COVID-19 (<i>n</i> = 67) patients, as well as ante mortem COVID-19 (<i>n</i> = 170) patients admitted to the University Medical Center Hamburg-Eppendorf (Hamburg, Germany). Baseline patient characteristics, parameters related to the intensive care unit (ICU) stay, and the clinical and autoptic presence of VTE were evaluated and statistically compared between groups. The occurrence of VTE in critically ill COVID-19 patients is confirmed in both ante mortem (17%) and postmortem (38%) cohorts. Accordingly, comparing the postmortem prevalence of VTE between age- and sex-matched COVID-19 (43%) and non-COVID-19 (0%) cohorts, we found the statistically significant increased prevalence of VTE in critically ill COVID-19 cohorts (<i>p</i> = 0.001). A change in anticoagulation practice was associated with the statistically significant prolongation of survival time (HR: 2.55, [95% CI 1.41–4.61], <i>p</i> = 0.01) and a reduction in VTE occurrence (54% vs. 25%; <i>p</i> = 0.02). In summary, in the autopsy as well as clinical cohort of critically ill patients with COVID-19, we found that VTE was a frequent finding. A change in anticoagulation practice was associated with a statistically significantly prolonged survival time.https://www.mdpi.com/1999-4915/14/4/811SARS-CoV-2COVID-19venous thromboembolismdeep vein thrombosispulmonary embolismrespiratory infections |
| spellingShingle | Fabian Heinrich Kevin Roedl Dominik Jarczak Hanna-Lisa Goebels Axel Heinemann Ulrich Schäfer Frank Ludwig Martin Bachmann Berthold Bein Christian Friedrich Weber Karsten Sydow Marc Bota Hans-Richard Paschen Andreas de Weerth Carsten Veit Oliver Detsch Philipp-Alexander Brand Stefan Kluge Benjamin Ondruschka Dominic Wichmann New Insights in the Occurrence of Venous Thromboembolism in Critically Ill Patients with COVID-19—A Large Postmortem and Clinical Analysis Viruses SARS-CoV-2 COVID-19 venous thromboembolism deep vein thrombosis pulmonary embolism respiratory infections |
| title | New Insights in the Occurrence of Venous Thromboembolism in Critically Ill Patients with COVID-19—A Large Postmortem and Clinical Analysis |
| title_full | New Insights in the Occurrence of Venous Thromboembolism in Critically Ill Patients with COVID-19—A Large Postmortem and Clinical Analysis |
| title_fullStr | New Insights in the Occurrence of Venous Thromboembolism in Critically Ill Patients with COVID-19—A Large Postmortem and Clinical Analysis |
| title_full_unstemmed | New Insights in the Occurrence of Venous Thromboembolism in Critically Ill Patients with COVID-19—A Large Postmortem and Clinical Analysis |
| title_short | New Insights in the Occurrence of Venous Thromboembolism in Critically Ill Patients with COVID-19—A Large Postmortem and Clinical Analysis |
| title_sort | new insights in the occurrence of venous thromboembolism in critically ill patients with covid 19 a large postmortem and clinical analysis |
| topic | SARS-CoV-2 COVID-19 venous thromboembolism deep vein thrombosis pulmonary embolism respiratory infections |
| url | https://www.mdpi.com/1999-4915/14/4/811 |
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