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Patients in the intensive care unit (ICU) for COVID-19 had high rates of major arterial or venous thromboembolism (VTE), major adverse cardiovascular events, and symptomatic VTE, according to data from the CORONA-VTE study presented at the American Heart Association Scientific Sessions 2020.&ldquo;Systemic inflammation, endothelial injury, immobility, and hypercoagulability are thought to promote thromboembolic complications especially in the critical care setting,&rdquo; explained study presenter Gregory Piazza, MD, MS, director of the vascular medicine section at Brigham and Women&rsquo;s Hospital. &ldquo;Quantifying the risk of cardiovascular complications in the heterogeneous population of patients with COVID-19 has been hampered by limited sample size, restriction of focus to the ICU setting, variable outcome definitions, and differing thromboprophylaxis patterns.&rdquo;To learn more, Dr. Piazza and colleagues analyzed 1,114 patients diagnosed with COVID-19 in their healthcare network. Patients were analyzed by site of care: ICU (n=170), hospitalized non-ICU (n=229), and outpatient setting (n=715). The cohort was 22.3% Hispanic/Latinx and 44.2% non-white. The primary study outcome was a composite of adjudicated major arterial or venous thromboembolism at 30 days.It was common for patients to have cardiovascular risk factors including hypertension (35.8%), hyperlipidemia (28.6%) and diabetes (18.0%). The median length of stay for the ICU cohort was 16 days and was 5 days for the admitted non-ICU cohort. Thirty percent of ICU patients were still hospitalized by 30 days. The majority (89.4%) of patients in the ICU cohort and the non-ICU hospitalized cohort (84.7%) were prescribed prophylactic anticoagulation.&ldquo;Major arterial or venous thromboembolism, major adverse cardiovascular events, and symptomatic VTE occurred with high frequency over 30 days in ICU patients with COVID-19 despite nearly 90% thromboprophylaxis,&rdquo; Dr. Piazza said.The incidence of major arterial or VTE (35.3%), major cardiovascular adverse events (45.9%) and symptomatic venous thromboembolism (27.0%) were highest in the ICU cohort, followed by the hospitalized non-ICU cohort (2.6%, 6.1%, 2.2%, respectively).&ldquo;Interestingly our outpatients did not have any observed major adverse events,&rdquo; Dr. Piazza said.The researchers analyzed time from COVID-19 PCR diagnosis to major arterial and VTE. The risk for major thromboembolic events and symptomatic VTE seemed to really increase for the ICU cohort at around 5 days, Dr. Piazza noted. For major cardiovascular events, the risk appeared to increase earlier in the ICU stay.Multivariable analyses showed that in the ICU cohort there was a nearly sevenfold increase in the odds of major arterial or VTE events associated with adult respiratory distress syndrome (ARDS; adjusted odds ratio [OR]=6.69; 95% CI, 1.85 to 24.14). There was also almost a sixfold increase in the odds of major cardiovascular events associated with ARDS (adjusted OR=5.79; 95% CI, 2.01 to 16.69) and a twofold increase related to male gender (adjusted OR=2.07; 95% CI, 1.02 to 3.64). There was a &ldquo;staggering&rdquo; 24-fold increased risk for symptomatic VTE associated with ARDS (adjusted OR=24.39; 95% CI, 1.50 to 398.00).Dr. Piazza noted that catheter- and device-related deep vein thrombosis comprised a large proportion of VTE in the ICU cohort and may have inflated the study&rsquo;s estimate. Additionally, although 30-day follow-up data were available for 96% of patients, the researchers were unable to obtain follow-up data for 40 outpatients and, therefore, they were likely to have underestimated 30-day outcomes in this cohort.

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Rates of Thromboembolic Complications High in COVID-19+ ICU Patients

AHA Scientific Sessions 2020

Patients in the intensive care unit (ICU) for COVID-19 had high rates of major arterial or venous thromboembolism (VTE), major adverse cardiovascular events, and symptomatic ...

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