Thromboembolic and bleeding events in ICU patients with COVID-19 - a nationwide, observational study

Lene Russell; Sarah Weihe; Emilie Kabel Madsen; Christine Lodberg Hvas; Jens Wolfgang Leistner; Jens Michelsen; Anne Craveiro Brøchner; Anders Bastiansen; Frederik Mølgaard Nielsen; Nick Meier; Anne Sofie Andreasen; Niels-Erik Ribergaard; Bodil Steen Rasmussen; Christoffer Grant Sølling; David Levarett Buck; Helle Bundgaard; Helle Scharling Pedersen; Iben Strøm Darfelt; Lone Musaeus Poulsen; Michael Ibsen; Ronni R Plovsing; Sigurdur T Sigurdsson; Susanne Iversen; Thomas Hildebrandt; Thomas Mohr; Ulrick Skipper Espelund; Vibeke Jørgensen; Nicolai Haase; Anders Perner

doi:10.1111/aas.14157

Thromboembolic and bleeding events in ICU patients with COVID-19 - a nationwide, observational study

Lene Russell^*, Sarah Weihe, Emilie Kabel Madsen, Christine Lodberg Hvas, Jens Wolfgang Leistner, Jens Michelsen, Anne Craveiro Brøchner, Anders Bastiansen, Frederik Mølgaard Nielsen, Nick Meier, Anne Sofie Andreasen, Niels-Erik Ribergaard, Bodil Steen Rasmussen, Christoffer Grant Sølling, David Levarett Buck, Helle Bundgaard, Helle Scharling Pedersen, Iben Strøm Darfelt, Lone Musaeus Poulsen, Michael IbsenRonni R Plovsing, Sigurdur T Sigurdsson, Susanne Iversen, Thomas Hildebrandt, Thomas Mohr, Ulrick Skipper Espelund, Vibeke Jørgensen, Nicolai Haase, Anders Perner

^*Corresponding author af dette arbejde

7 Citationer (Scopus)

Abstract

BACKGROUND: Intensive care unit (ICU) patients with Coronavirus disease 2019 (COVID-19) have an increased risk of thromboembolic complications. We describe the occurrence of thromboembolic and bleeding events in all ICU patients with COVID-19 in Denmark during the first and second waves of the pandemic.

METHODS: This was a sub-study of the Danish Intensive Care Covid database, in which all patients with SARS-CoV-2 admitted to Danish ICUs from 10th March 2020 to 30th June 2021 were included. We registered coagulation variables at admission, and all thromboembolic and bleeding events, and the use of heparins during ICU stay. Variables associated with thrombosis and bleeding and any association with 90-day mortality were estimated using Cox regression analyses.

RESULTS: We included 1369 patients in this sub-study; 158 (12%, 95% confidence interval 10-13) had a thromboembolic event in ICU and 309 (23%, 20-25) had a bleeding event, among whom 81 patients (6%, 4.8-7.3) had major bleeding. We found that mechanical ventilation and increased D-dimer were associated with thrombosis and mechanical ventilation, low platelet count and presence of haematological malignancy were associated with bleeding. Most patients (76%) received increased doses of thromboprophylaxis during their ICU stay. Thromboembolic events were not associated with mortality in adjusted analysis (hazard ratio 1.35 [0.91-2.01, p = .14], whereas bleeding events were 1.55 [1.18-2.05, p = .002]).

CONCLUSIONS: Both thromboembolic and bleeding events frequently occurred in ICU patients with COVID-19. Based on these data, it is not apparent that increased doses of thromboprophylaxis were beneficial.

Originalsprog	Engelsk
Tidsskrift	Acta Anaesthesiologica Scandinavica
Vol/bind	67
Udgave nummer	1
Sider (fra-til)	76-85
Antal sider	10
ISSN	0001-5172
DOI	https://doi.org/10.1111/aas.14157
Status	Udgivet - jan. 2023

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10.1111/aas.14157Licens: CC BY-NC-ND

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Russell, L., Weihe, S., Madsen, E. K., Hvas, C. L., Leistner, J. W., Michelsen, J., Brøchner, A. C., Bastiansen, A., Mølgaard Nielsen, F., Meier, N., Andreasen, A. S., Ribergaard, N.-E., Rasmussen, B. S., Sølling, C. G., Buck, D. L., Bundgaard, H., Pedersen, H. S., Darfelt, I. S., Poulsen, L. M., ... Perner, A. (2023). Thromboembolic and bleeding events in ICU patients with COVID-19 - a nationwide, observational study. Acta Anaesthesiologica Scandinavica, 67(1), 76-85. https://doi.org/10.1111/aas.14157

Russell, L, Weihe, S, Madsen, EK, Hvas, CL, Leistner, JW, Michelsen, J, Brøchner, AC, Bastiansen, A, Mølgaard Nielsen, F, Meier, N, Andreasen, AS, Ribergaard, N-E, Rasmussen, BS, Sølling, CG, Buck, DL, Bundgaard, H, Pedersen, HS, Darfelt, IS, Poulsen, LM, Ibsen, M , Plovsing, RR , Sigurdsson, ST, Iversen, S, Hildebrandt, T, Mohr, T, Espelund, US, Jørgensen, V , Haase, N & Perner, A 2023, 'Thromboembolic and bleeding events in ICU patients with COVID-19 - a nationwide, observational study', Acta Anaesthesiologica Scandinavica, bind 67, nr. 1, s. 76-85. https://doi.org/10.1111/aas.14157

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title = "Thromboembolic and bleeding events in ICU patients with COVID-19 - a nationwide, observational study",

abstract = "BACKGROUND: Intensive care unit (ICU) patients with Coronavirus disease 2019 (COVID-19) have an increased risk of thromboembolic complications. We describe the occurrence of thromboembolic and bleeding events in all ICU patients with COVID-19 in Denmark during the first and second waves of the pandemic.METHODS: This was a sub-study of the Danish Intensive Care Covid database, in which all patients with SARS-CoV-2 admitted to Danish ICUs from 10th March 2020 to 30th June 2021 were included. We registered coagulation variables at admission, and all thromboembolic and bleeding events, and the use of heparins during ICU stay. Variables associated with thrombosis and bleeding and any association with 90-day mortality were estimated using Cox regression analyses.RESULTS: We included 1369 patients in this sub-study; 158 (12%, 95% confidence interval 10-13) had a thromboembolic event in ICU and 309 (23%, 20-25) had a bleeding event, among whom 81 patients (6%, 4.8-7.3) had major bleeding. We found that mechanical ventilation and increased D-dimer were associated with thrombosis and mechanical ventilation, low platelet count and presence of haematological malignancy were associated with bleeding. Most patients (76%) received increased doses of thromboprophylaxis during their ICU stay. Thromboembolic events were not associated with mortality in adjusted analysis (hazard ratio 1.35 [0.91-2.01, p = .14], whereas bleeding events were 1.55 [1.18-2.05, p = .002]).CONCLUSIONS: Both thromboembolic and bleeding events frequently occurred in ICU patients with COVID-19. Based on these data, it is not apparent that increased doses of thromboprophylaxis were beneficial.",

keywords = "bleeding, COVID-19, thromboprophylaxis, thrombosis",

author = "Lene Russell and Sarah Weihe and Madsen, {Emilie Kabel} and Hvas, {Christine Lodberg} and Leistner, {Jens Wolfgang} and Jens Michelsen and Br{\o}chner, {Anne Craveiro} and Anders Bastiansen and {M{\o}lgaard Nielsen}, Frederik and Nick Meier and Andreasen, {Anne Sofie} and Niels-Erik Ribergaard and Rasmussen, {Bodil Steen} and S{\o}lling, {Christoffer Grant} and Buck, {David Levarett} and Helle Bundgaard and Pedersen, {Helle Scharling} and Darfelt, {Iben Str{\o}m} and Poulsen, {Lone Musaeus} and Michael Ibsen and Plovsing, {Ronni R} and Sigurdsson, {Sigurdur T} and Susanne Iversen and Thomas Hildebrandt and Thomas Mohr and Espelund, {Ulrick Skipper} and Vibeke J{\o}rgensen and Nicolai Haase and Anders Perner",

year = "2023",

month = jan,

doi = "10.1111/aas.14157",

language = "English",

volume = "67",

pages = "76--85",

journal = "Acta Anaesthesiologica Scandinavica",

issn = "0001-5172",

publisher = "Wiley-Blackwell Munksgaard",

number = "1",

}

TY - JOUR

T1 - Thromboembolic and bleeding events in ICU patients with COVID-19 - a nationwide, observational study

AU - Russell, Lene

AU - Weihe, Sarah

AU - Madsen, Emilie Kabel

AU - Hvas, Christine Lodberg

AU - Leistner, Jens Wolfgang

AU - Michelsen, Jens

AU - Brøchner, Anne Craveiro

AU - Bastiansen, Anders

AU - Mølgaard Nielsen, Frederik

AU - Meier, Nick

AU - Andreasen, Anne Sofie

AU - Ribergaard, Niels-Erik

AU - Rasmussen, Bodil Steen

AU - Sølling, Christoffer Grant

AU - Buck, David Levarett

AU - Bundgaard, Helle

AU - Pedersen, Helle Scharling

AU - Darfelt, Iben Strøm

AU - Poulsen, Lone Musaeus

AU - Ibsen, Michael

AU - Plovsing, Ronni R

AU - Sigurdsson, Sigurdur T

AU - Iversen, Susanne

AU - Hildebrandt, Thomas

AU - Mohr, Thomas

AU - Espelund, Ulrick Skipper

AU - Jørgensen, Vibeke

AU - Haase, Nicolai

AU - Perner, Anders

PY - 2023/1

Y1 - 2023/1

N2 - BACKGROUND: Intensive care unit (ICU) patients with Coronavirus disease 2019 (COVID-19) have an increased risk of thromboembolic complications. We describe the occurrence of thromboembolic and bleeding events in all ICU patients with COVID-19 in Denmark during the first and second waves of the pandemic.METHODS: This was a sub-study of the Danish Intensive Care Covid database, in which all patients with SARS-CoV-2 admitted to Danish ICUs from 10th March 2020 to 30th June 2021 were included. We registered coagulation variables at admission, and all thromboembolic and bleeding events, and the use of heparins during ICU stay. Variables associated with thrombosis and bleeding and any association with 90-day mortality were estimated using Cox regression analyses.RESULTS: We included 1369 patients in this sub-study; 158 (12%, 95% confidence interval 10-13) had a thromboembolic event in ICU and 309 (23%, 20-25) had a bleeding event, among whom 81 patients (6%, 4.8-7.3) had major bleeding. We found that mechanical ventilation and increased D-dimer were associated with thrombosis and mechanical ventilation, low platelet count and presence of haematological malignancy were associated with bleeding. Most patients (76%) received increased doses of thromboprophylaxis during their ICU stay. Thromboembolic events were not associated with mortality in adjusted analysis (hazard ratio 1.35 [0.91-2.01, p = .14], whereas bleeding events were 1.55 [1.18-2.05, p = .002]).CONCLUSIONS: Both thromboembolic and bleeding events frequently occurred in ICU patients with COVID-19. Based on these data, it is not apparent that increased doses of thromboprophylaxis were beneficial.

AB - BACKGROUND: Intensive care unit (ICU) patients with Coronavirus disease 2019 (COVID-19) have an increased risk of thromboembolic complications. We describe the occurrence of thromboembolic and bleeding events in all ICU patients with COVID-19 in Denmark during the first and second waves of the pandemic.METHODS: This was a sub-study of the Danish Intensive Care Covid database, in which all patients with SARS-CoV-2 admitted to Danish ICUs from 10th March 2020 to 30th June 2021 were included. We registered coagulation variables at admission, and all thromboembolic and bleeding events, and the use of heparins during ICU stay. Variables associated with thrombosis and bleeding and any association with 90-day mortality were estimated using Cox regression analyses.RESULTS: We included 1369 patients in this sub-study; 158 (12%, 95% confidence interval 10-13) had a thromboembolic event in ICU and 309 (23%, 20-25) had a bleeding event, among whom 81 patients (6%, 4.8-7.3) had major bleeding. We found that mechanical ventilation and increased D-dimer were associated with thrombosis and mechanical ventilation, low platelet count and presence of haematological malignancy were associated with bleeding. Most patients (76%) received increased doses of thromboprophylaxis during their ICU stay. Thromboembolic events were not associated with mortality in adjusted analysis (hazard ratio 1.35 [0.91-2.01, p = .14], whereas bleeding events were 1.55 [1.18-2.05, p = .002]).CONCLUSIONS: Both thromboembolic and bleeding events frequently occurred in ICU patients with COVID-19. Based on these data, it is not apparent that increased doses of thromboprophylaxis were beneficial.

KW - bleeding

KW - COVID-19

KW - thromboprophylaxis

KW - thrombosis

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U2 - 10.1111/aas.14157

DO - 10.1111/aas.14157

M3 - Journal article

C2 - 36263897

SN - 0001-5172

VL - 67

SP - 76

EP - 85

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 1

ER -

Thromboembolic and bleeding events in ICU patients with COVID-19 - a nationwide, observational study

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