scholarly journals Thrombotic complications in 2928 patients with COVID-19 treated in intensive care: a systematic review

2021 ◽  
Vol 51 (3) ◽  
pp. 595-607
Author(s):  
William J. Jenner ◽  
Rahim Kanji ◽  
Saeed Mirsadraee ◽  
Ying X. Gue ◽  
Susanna Price ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
Venous Thrombosis ◽  
Severe Disease ◽  
Duplex Ultrasound ◽  
Clinical Suspicion ◽  
Systematic Screening ◽  
Patient Demographics ◽  
Included Patient ◽  
Thrombotic Complications

AbstractA prothrombotic state is reported with severe COVID-19 infection, which can manifest in venous and arterial thrombotic events. Coagulopathy is reflective of more severe disease and anticoagulant thromboprophylaxis is recommended in hospitalized patients. However, the prevalence of thrombosis on the intensive care unit (ICU) remains unclear, including whether this is sufficiently addressed by conventional anticoagulant thromboprophylaxis. We aimed to identify the rate of thrombotic complications in ICU-treated patients with COVID-19, to inform recommendations for diagnosis and management. A systematic review was conducted to assess the incidence of thrombotic complications in ICU-treated patients with COVID-19. Observational studies and registries reporting thrombotic complications in ICU-treated patients were included. Information extracted included patient demographics, use of thromboprophylaxis or anticoagulation, method of identifying thrombotic complications, and reported patient outcomes. In 28 studies including 2928 patients, thrombotic complications occurred in 34% of ICU-managed patients, with deep venous thrombosis reported in 16.1% and pulmonary embolism in 12.6% of patients, despite anticoagulant thromboprophylaxis, and were associated with high mortality. Studies adopting systematic screening for venous thrombosis with Duplex ultrasound reported a significantly higher incidence of venous thrombosis compared to those relying on clinical suspicion (56.3% vs. 11.0%, p < 0.001). Despite thromboprophylaxis, there is a very high incidence of thrombotic complications in patients with COVID-19 on the ICU. Systematic screening identifies many thrombotic complications that would be missed by relying on clinical suspicion and should be employed, with consideration given to increased dose anticoagulant thromboprophylaxis, whilst awaiting results of prospective trials of anticoagulation in this cohort.

A new factor of postoperative venous thrombosis in oncology: myth or reality?

2020 ◽  
Author(s):  
О.И. Кит ◽  
О.В. Кательницкая ◽  
И.И. Кательницкий ◽  
Н.С. Карнаухов ◽  
Е.В. Вереникина ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
High Rate ◽  
Oncological Patients ◽  
Single Centre Study ◽  
Endovenous Thermal Ablation ◽  
Thrombotic Complications ◽  
Morphologic Analysis ◽  
Anticoagulant Prophylaxis

Введение. Эндовенозная термическая абляция (ЭТА) поверхностных вен, включая лазерную абляцию или радиочастотную абляцию, широко применяется в лечении варикозной болезни нижних конечностей. Учитывая высокую частоту встречаемости варикозной болезни, частоту венозных тромбоэмболических осложнений (ВТЭО) после данного вмешательства, логично предположить, что выполнение ЭТА увеличит риск возникновения послеоперационного венозного тромбоза у онкологических больных. Существует недостаток данных о частоте ВТЭО в онкохирургии при ЭТА в анамнезе. Цель исследования: оценить влияние ранее проведенной ЭТА поверхностных вен нижних конечностей на послеоперационные ВТЭО в онкохирургии. Материалы и методы. Одноцентровое исследование с ретроспективным анализом онкологических больных на хирургическом этапе лечения злокачественных опухолей абдоминальной, гинекологической или урологической локализации проведено с мая 2013 г. по ноябрь 2018 г. В исследование были включены 36 пациентов, перенесших ЭТА более 3 мес назад (319 мес). Ультразвуковое дуплексное исследование вен нижних конечностей проводили перед операцией (за 110 дней) по поводу онкологического заболевания всем пациентам. Полная облитерация ствола большой подкожной вены (БПкВ) обнаружена в 66,7 случаев (n 24), реканализация в 33,3 (n 12). Все пациенты получали стандартную антикоагулянтную профилактику (надропарин по 0,4 мл/сут подкожно). Проведен морфологический анализ 3 случаев послеоперационного венозного тромбоза. Результаты. ВТЭО возникли в 20,8 (n 5) случаев при полной облитерации БПкВ, в 66,7 (n 8) с реканализацией ствола (95 ДИ 1,37,7) в послеоперационном периоде. Реканализация вены увеличила частоту развития послеоперационного венозного тромбоза в 3,2 раза. Заключение. ВТЭО часто возникают после неполной облитерации при ЭТА в отдаленном периоде при наличии дополнительных факторов риска. Учитывая широкое распространение данного типа операций во флебологии и возможность серьезных осложнений, необходимы дальнейшие исследования частоты венозного тромбоза при ЭТА в анамнезе у онкологических больных и определение стратегии профилактики ВТЭО. Introduction. Endovenous thermal ablation of saphenous vein (EVTA SV) including laser ablation or radiofrequency ablation widely used in varicose veins treatment of the lower extremities. EVTA SV can increase the risk of postoperative venous thrombosis in cancer patients. There is a deficiency of data examining rates of thrombotic events (VTE) in oncological patients. Aim: to assess influence of previously performed EVTA SV on postoperative VTE in oncosurgery. Materials and methods. This was a single centre study with retrospective analysis of consecutive oncological patients who underwent abdominal, gynecological or urological surgery from May 2013 to November 2018. 36 patients were included who underwent EVTA SV more than 3 month ago (319 months). Duplex ultrasound (DUS) was performed before oncological surgery (110 days). Complete SV obliteration was found in 66.7 of cases (n 24), recanalization in 33.3 (n 12). All patients had standard anticoagulant prophylaxis nadroparin 0.4 ml per day. We performed a morphologic analysis of 3 VTE cases. Results. Thrombotic complications occurred in 20.8 (n 5) of cases with complete SV obliteration, in 66.7 (n 8) with recanalization (95 CI 1.37.7). Recanalization of SV increased rate of postoperative cancer-associated VTE in 3.2 times. Conclusion. Thrombotic events occur frequently following incomplete obliteration after procedures EVTA SV. Taken account of the high rate of this procedures and the potential for serious consequences, further research is needed on VTE сomplications in oncology and their management.

scholarly journals Asymmetry indicates more severe and active disease in Graves’ orbitopathy: results from a prospective cross-sectional multicentre study

2020 ◽  
Vol 43 (12) ◽  
pp. 1717-1722 ◽  
Author(s):  
P. Perros ◽  
◽  
M. P. Žarković ◽  
G. C. Panagiotou ◽  
C. Azzolini ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Severe Disease ◽  
Clinical Parameter ◽  
Cross Sectional ◽  
Multi Centre Study ◽  
Patient Demographics ◽  
Male Ratio ◽  
Included Patient ◽  
Graves Orbitopathy ◽  
Active Disease

Abstract Purpose Patients with Graves’ orbitopathy can present with asymmetric disease. The aim of this study was to identify clinical characteristics that distinguish asymmetric from unilateral and symmetric Graves’ orbitopathy. Methods This was a multi-centre study of new referrals to 13 European Group on Graves’ Orbitopathy (EUGOGO) tertiary centres. New patients presenting over a 4 month period with a diagnosis of Graves’ orbitopathy were included. Patient demographics were collected and a clinical examination was performed based on a previously published protocol. Patients were categorized as having asymmetric, symmetric, and unilateral Graves’ orbitopathy. The distribution of clinical characteristics among the three groups was documented. Results The asymmetric group (n = 83), was older than the symmetric (n = 157) group [mean age 50.9 years (SD 13.9) vs 45.8 (SD 13.5), p = 0.019], had a lower female to male ratio than the symmetric and unilateral (n = 29) groups (1.6 vs 5.0 vs 8.7, p < 0.001), had more active disease than the symmetric and unilateral groups [mean linical Activity Score 3.0 (SD 1.6) vs 1.7 (SD 1.7), p < 0.001 vs 1.3 (SD 1.4), p < 0.001] and significantly more severe disease than the symmetric and unilateral groups, as measured by the Total Eye Score [mean 8.8 (SD 6.6) vs 5.3 (SD 4.4), p < 0.001, vs 2.7 (SD 2.1), p < 0.001]. Conclusion Older age, lower female to male ratio, more severe, and more active disease cluster around asymmetric Graves’ orbitopathy. Asymmetry appears to be a marker of more severe and more active disease than other presentations. This simple clinical parameter present at first presentation to tertiary centres may be valuable to clinicians who manage such patients.

scholarly journals Smoking and Comorbidities in Covid-19: A Systematic Review

2020 ◽  
Vol 9 (2) ◽  
pp. 117-125
Author(s):  
Andri Nugraha ◽  
Ernawati Ernawati ◽  
Tuti Anggriani Utama ◽  
Santi Rinjani
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
High Risk ◽  
Full Text ◽  
Severe Disease ◽  
Severe Illness ◽  
Severe Infections

COVID-19 is highly contagious, causing pneumonia, respiratory failure, death, and becoming a pandemic. Patients with severe infections must be treated in the Intensive Care Unit (ICU) with a ventilator. Ventilator facilities in the ICU are limited; it must take precautions by knowing the characteristics of patients at high risk of severe disease in COVID-19, one of which was smoking or comorbidity. The purpose of this study was to assess the risk of comorbidity and smoking in COVID-19. This study used systematic review by searching for articles from the ScienceDirect and Medline databases with journals published on January 1, 2019 - March 31, 2020. The results of the study showed that there were 12 relevant articles full text in English and were analysed. The conclusion was that patients with COVID-19 who were smoking or had comorbidities were more susceptible to COVID-19 infection, more severe illness, and causing death.

scholarly journals Low incidence of venous thrombosis but high incidence of arterial thrombotic complications among critically ill COVID-19 patients in Singapore

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Chuen Wen Tan ◽  
◽  
Bingwen Eugene Fan ◽  
Winnie Z. Y. Teo ◽  
Moon Ley Tung ◽  
...  
Keyword(s):  
Intensive Care ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Critically Ill ◽  
Arterial Thrombosis ◽  
Bleeding Rate ◽  
High Incidence ◽  
Major Bleeding Rate ◽  
Thrombotic Complications ◽  
Low Incidence

Abstract Background Arterial and venous thrombosis are reported to be common in critically ill COVID-19 patients. Method and results This is a national multicenter retrospective observational study involving all consecutive adult COVID-19 patients who required intensive care units (ICU) admission between 23 January 2020 and 30 April 2020 in Singapore. One hundred eleven patients were included and the venous and arterial thrombotic rates in ICU were 1.8% (n = 2) and 9.9% (n = 11), respectively. Major bleeding rate was 14.8% (n = 16). Conclusions Critically ill COVID-19 patients in Singapore have lower venous thromboembolism but higher arterial thrombosis rates and bleeding manifestations than other reported cohorts.

scholarly journals Low incidence of venous thrombosis but high incidence of arterial thrombotic complications among critically ill COVID-19 patients in Singapore

2021 ◽  
Author(s):  
Chuen Wen Tan ◽  
Bingwen Eugene Fan ◽  
Winnie Z.Y. Teo ◽  
Moon Ley Tung ◽  
Humaira Shafi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Critically Ill ◽  
Arterial Thrombosis ◽  
Bleeding Rate ◽  
High Incidence ◽  
Major Bleeding Rate ◽  
Thrombotic Complications ◽  
Low Incidence

Abstract Background: Arterial and venous thrombosis are reported to be common in critically ill COVID-19 patients.Method and Results: This is a national multicenter retrospective observational study involving all consecutive adult COVID-19 patients who required intensive care units (ICU) admission between 23 January 2020 and 30 April 2020 in Singapore. 111 patients were included and the venous and arterial thrombotic rates in ICU were 1.8% (n=2) and 9.9% (n=11), respectively. Major bleeding rate was 14.8% (n=16). Conclusions: Critically ill COVID-19 patients in Singapore have lower venous thromboembolism but higher arterial thrombosis rates and bleeding manifestations than other reported cohorts.

scholarly journals Venous Thromboembolism in Hospitalized COVID-19 Patients: Systematic Review (Preprint)

2020 ◽  
Author(s):  
Kade Birkeland ◽  
Raymond Zimmer ◽  
Asher Kimchi ◽  
Ilan Kedan
Keyword(s):  
Systematic Review ◽  
Venous Thromboembolism ◽  
Patient Characteristics ◽  
Journal Articles ◽  
Microsoft Excel ◽  
Systematic Screening ◽  
Diagnostic Strategies ◽  
Vte Prophylaxis ◽  
Search Terms ◽  
Included Patient

BACKGROUND Coagulopathy associated with COVID-19 infection and venous thromboembolism (VTE) have emerged as significant contributors to morbidity among patients infected with SARS-CoV-2. OBJECTIVE We performed a systematic review to estimate VTE incidence in hospitalized patients and to analyze characteristic factors in the VTE cohort. METHODS We searched PubMed and Google Scholar using specified title search terms “SARS-CoV-2” or “COVID-19” and “venous thromboembolism” and “anticoagulation” among others to identify peer-reviewed journal articles published between June 22, 2019, and June 22, 2020. Data were systematically extracted and synthesized using Microsoft Excel for analysis. The main outcome was VTE incidence, and measures included patient characteristics, anticoagulation, and clinical outcomes with assessment for associations. RESULTS In total, 14 studies were included comprising 1677 patients. Most patients (n=1306, 82.4%) received anticoagulation (either VTE prophylaxis or treatment). VTE incidence was 26.9% (SE 3.1; 95% CI 20.8-33.1) and was correlated with systematic screening (r<sup>2</sup>=0.34, <i>P</i>=.03) and study duration (r<sup>2</sup>=–0.33, <i>P</i>=.03). D-dimer was higher for the VTE cohort (5.62 [SD 0.9] vs 1.43 [SD 0.6]; <i>P</i>&lt;.001). Odds of VTE were higher at the intensive care unit (odds ratio [OR] 6.38, 95% CI 3.67-11.11; <i>P</i>&lt;.001) but lower with anticoagulation (OR 0.58, 95% CI 0.36-0.92; <i>P</i>=.02). CONCLUSIONS Despite the utilization of background anticoagulation, VTE incidence was historically high. Future studies are needed to provide additional data to guide optimal VTE prophylaxis and diagnostic strategies.

What We Know (and Do not Know) Regarding the Pathogenesis of Pulmonary Thrombosis in COVID-19

2022 ◽  
Author(s):  
Giuseppe Lippi ◽  
Emmanuel J. Favaloro
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Venous Thrombosis ◽  
Active Phase ◽  
Severe Illness ◽  
Pulmonary Tissue ◽  
Systematic Screening ◽  
Vein Thrombosis ◽  
Pulmonary Thrombosis ◽  
Deep Vein

AbstractThe clinical course of coronavirus disease 2019 (COVID-19) is often complicated by the onset of venous thrombosis and thromboembolism (VTE), encompassing also pulmonary thrombosis. Recent statistics attests that the cumulative frequency of VTE can be as high as 30% in COVID-19 hospitalized patients, increasing to nearly 40 to 70% (depending on systematic screening) in those with severe illness, mechanical ventilation, or intensive care unit admission. The risk of venous thrombosis seems mostly limited to the active phase of disease, and is directly associated with some genetic (i.e., inherited prothrombotic predisposition) and demographical factors (male sex, overweight/obesity), disease severity (risk increasing progressively from hospitalization to development of severe illness, being the highest in patients needing mechanical ventilation and/or intensive care), presence and extent of pulmonary disease, coexistence of multiple risk factors (immobilization, mechanical ventilation, co- or superinfections), along with increased values of inflammatory and thrombotic biomarkers. At least three different phenotypes of pulmonary thrombosis may develop in COVID-19 patients, one caused by typical embolization from peripheral venous thrombosis (e.g., deep vein thrombosis), a second type triggered by local inflammation of nearby pulmonary tissue, and a third one mostly attributable to the prothrombotic state consequent to the pronounced systemic inflammatory response (i.e., the so-called cytokine storm) that is frequently observed in COVID-19. Although the pathogenesis of these three conditions has different features, their discrimination is essential for diagnostic and therapeutic purposes. The prognosis of COVID-19 patients who develop pulmonary thrombosis is also considerably worse than those who do not, thus probably needing frequent monitoring and more aggressive therapeutic management.

scholarly journals COVID-19 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review of critically unwell children and the association with underlying comorbidities

2020 ◽  
Author(s):  
Nia Williams ◽  
Trisha Radia ◽  
Katharine Harman ◽  
Pankaj Agrawal ◽  
James Cook ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
Medical History ◽  
Cardiac Disease ◽  
Severe Disease ◽  
Past Medical History ◽  
Inclusion Criteria ◽  
Number Of Children ◽  
The Past ◽  
Meta Analyses

Abstract Data show that children are less severely affected with SARS-Covid-19 than adults; however, there have been a small proportion of children who have been critically unwell. In this systematic review, we aimed to identify and describe which underlying comorbidities may be associated with severe SARS-CoV-2 disease and death. The study protocol was in keeping with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A total of 1726 articles were identified of which 28 studies fulfilled the inclusion criteria. The 28 studies included 5686 participants with confirmed SARS-CoV-2 infection ranging from mild to severe disease. We focused on the 108 patients who suffered from severe/critical illness requiring ventilation, which included 17 deaths. Of the 108 children who were ventilated, the medical history was available for 48 patients. Thirty-six of the 48 patients (75%) had documented comorbidities of which 11/48 (23%) had pre-existing cardiac disease. Of the 17 patients who died, the past medical history was reported in 12 cases. Of those, 8/12 (75%) had comorbidities. Conclusion: Whilst only a small number of children suffer from COVID-19 disease compared to adults, children with comorbidities, particularly pre-existing cardiac conditions, represent a large proportion of those that became critically unwell. What is Known:• Children are less severely affected by SARS-CoV-2 than adults.• There are reports of children becoming critically unwell with SARS-CoV-2 and requiring intensive care. What is New:• The majority of children who required ventilation for SARS-CoV-2 infection had underlying comorbidities.• The commonest category of comorbidity in these patients was underlying cardiac disease.

scholarly journals Child with tuberculous meningitis and COVID-19 coinfection complicated by extensive cerebral sinus venous thrombosis

2020 ◽  
Vol 13 (9) ◽  
pp. e238597
Author(s):  
Farida Essajee ◽  
Regan Solomons ◽  
Pierre Goussard ◽  
Ronald Van Toorn
Keyword(s):  
Venous Thrombosis ◽  
Tuberculous Meningitis ◽  
Severe Disease ◽  
Coagulation System ◽  
Viral Shedding ◽  
Cerebral Sinus Venous Thrombosis ◽  
Arterial Ischaemic Stroke ◽  
Thrombotic Complications ◽  
Cerebral Sinus ◽  
Sinus Venous Thrombosis

We herein report a case of a child with tuberculous meningitis and COVID-19 coinfection complicated by hydrocephalus, arterial ischaemic stroke and extensive cerebral sinus venous thrombosis. Both conditions induce a proinflammatory cytokine drive resulting, among others, in a prothrombotic state. The disruption of the coagulation system in this case was supported by elevated D-dimers, fibrinogen and ferritin levels, consistent with thrombotic complications reported in some adult patients infected with COVID-19. The child also exhibited prolonged viral shedding that suggests severe disease.

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