Venous Thrombosis and SARS-CoV-2

2021 ◽  
Author(s):  
Monika Zdanyte ◽  
Dominik Rath ◽  
Meinrad Gawaz ◽  
Tobias Geisler
Keyword(s):  
Intensive Care Unit ◽  
Pulmonary Embolism ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Vascular Endothelium ◽  
Arterial Thrombosis ◽  
Review Article ◽  
Prevention And Treatment ◽  
All Cause Mortality ◽  
Thrombotic Complications

AbstractSARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection is associated with high risk of venous and arterial thrombosis. Thrombotic complications, especially pulmonary embolism, lead to increased all-cause mortality in both intensive care unit and noncritically ill patients. Damage and activation of vascular endothelium, platelet activation, followed by thrombotic and fibrinolytic imbalance as well as hypercoagulability are the key pathomechanisms in immunothrombosis leading to a significant increase in thromboembolism in coronavirus disease 2019 (COVID-19) compared with other acute illnesses. In this review article, we discuss the incidence and prognosis, diagnosis, prevention, and treatment of venous thromboembolism in patients with COVID-19 disease, based on clinical experience and research available to date.

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 Comparing Bleeding and Thrombotic Rates in Spine Surgery: An Analysis of 119 888 Patients

2019 ◽  
pp. 219256821989629
Author(s):  
Sean Pirkle ◽  
David J. Cook ◽  
Samuel Kaskovich ◽  
Sarah Bhattacharjee ◽  
Alisha Ho ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Pulmonary Embolism ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Spine Surgery ◽  
Postoperative Bleeding ◽  
Bleeding Complications ◽  
Prior History ◽  
Dvt Prophylaxis ◽  
Thrombotic Complications

Study Design: Retrospective, database review. Objectives: Examine the utilization rate of postoperative deep vein thrombosis (DVT) prophylaxis and compare the incidence and severity of bleeding and thrombotic complications in elective spine surgery patients. Methods: We utilized PearlDiver, a national orthopedics claims database. All patients who underwent elective spine surgery from 2007 to 2017 were included. Patients were stratified by the presence of DVT prophylaxis drug codes, then by comorbidities for postoperative bleeding/thrombosis. The severity of all bleeding and thrombotic complications in each cohort was studied, including the incidence of complications requiring operative washout, diagnosis of pulmonary embolism, intensive care unit admission, and mortality. Results: A total of 119 888 patients were included. The majority of patients (118 720, >99%) were not administered postoperative DVT chemoprophylaxis while a minority of patients (1168) were. The overall rates of bleeding and thrombotic complications within the population not receiving DVT prophylaxis were 1.96% and 2.45%, respectively ( P < .001). The incidence of surgical intervention for a wound washout was 0.62% compared with 1.05% for pulmonary embolism ( P < .001). Intensive care unit admission rates related to a wound washout procedure or pulmonary embolism also significantly differed (0.07% vs 0.34%, P < .001). There were no observed differences in mortality. When controlling for patient comorbidity, patients with atrial fibrillation, cancer, or a prior history of thrombotic complications experienced the greatest increased risks of postoperative thrombosis. Conclusions: DVT prophylaxis is not routinely utilized following elective spine procedures. We report that there exist specific populations which may receive benefit from these practices, although further study is necessary to determine optimal prevention strategies for both thrombotic and bleeding complications in spine surgery.

scholarly journals Risk factors for venous thromboembolism after carbon monoxide poisoning: A nationwide population-based study

2021 ◽  
pp. 102490792199442
Author(s):  
Yongil Cho ◽  
Tae Ho Lim ◽  
Byuk Sung Ko ◽  
Hyunggoo Kang ◽  
Jaehoon Oh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Carbon Monoxide ◽  
Pulmonary Embolism ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Intensive Care Unit Admission ◽  
Carbon Monoxide Poisoning ◽  
Vein Thrombosis ◽  
Deep Vein

Introduction: The risk of venous thromboembolism increases after acute carbon monoxide poisoning. However, studies on the characteristics of patients who develop venous thromboembolism after carbon monoxide poisoning are rare. The aim of this study was to identify the risk factors for venous thromboembolism within 3 months after carbon monoxide poisoning. Methods: This is a population-based study that employed nationwide claims data from South Korea. Among the carbon monoxide poisoning patients (⩾18 years), the characteristics of the groups with and without venous thromboembolism (pulmonary embolism or deep vein thrombosis) were identified. All the significant variables in the univariable analysis were included in the multivariable logistic regression to determine the risk factors for venous thromboembolism occurrence. Results: Among the 24,232 carbon monoxide poisoning patients, 130 subjects developed venous thromboembolism within 90 days of their carbon monoxide poisoning diagnosis. The significant risk factors for venous thromboembolism in the multivariable analysis were age (adjusted odds ratio (aOR) = 1.01; 95% confidence interval (CI) = 1.003–1.03), intensive care unit admission (aOR = 3.80; 95% CI = 2.34–6.12), length of stay (aOR = 1.02; 95% CI = 1.0001–1.04), congestive heart failure (aOR = 2.17; 95% CI = 1.36–3.42), and cancer (aOR = 1.94; 95% CI = 1.10–3.22). The adjusted odds ratios for intensive care unit admission for patients with pulmonary embolism and deep vein thrombosis were 3.05 (95% CI = 1.61–5.61) and 5.60 (95% CI = 2.89–10.90), respectively. Conclusion: Patients with older age, intensive care unit admission, a longer length of stay, congestive heart failure, or cancer are at greater risk of developing venous thromboembolism after carbon monoxide poisoning. In particular, intensive care unit admission was the strongest risk factor for venous thromboembolism, pulmonary embolism, and deep vein thrombosis. Monitoring and administering prophylactic treatments to prevent venous thromboembolism would be helpful in high-risk in carbon monoxide poisoning patients.

scholarly journals Low Incidence of Venous Thrombosis But High Incidence of Arterial Thrombotic Complications Among Critically Ill COVID-19 Patients in Singapore

2020 ◽  
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.

The (Absence of a) Role of Venous Duplex Scan in the Diagnosis of Pulmonary Embolism after Severe Trauma

2006 ◽  
Vol 72 (1) ◽  
pp. 7-10
Author(s):  
George C. Velmahos ◽  
Carlos V. Brown ◽  
Demetrios Demetriades
Keyword(s):  
Intensive Care Unit ◽  
Pulmonary Embolism ◽  
Intensive Care ◽  
Sensitivity And Specificity ◽  
Clinical Suspicion ◽  
Severely Injured ◽  
Duplex Scan ◽  
Severely Injured Patients ◽  
High Level ◽  
Injured Patients

Venous duplex scan (VDS) has been used for interim bedside diagnosis of pulmonary embolism (PE) in severely injured patients deemed to be at risk if transported out of the intensive care unit. In combination with the level of clinical suspicion for PE, VDS helps select patients for temporary treatment until definitive diagnosis is made. We evaluate the sensitivity and specificity of VDS in critically injured patients with a high level of clinical suspicion for PE. We performed a prospective observational cohort study at the surgical intensive care unit of an academic level 1 trauma center. Patients were 59 critically injured patients suspected to have PE over a 30-month period. The level of clinical suspicion for PE was classified as low or high according to preset criteria. Interventions were VDS and a PE outcome test (conventional or computed tomographic pulmonary angiography). The sensitivity and specificity of VDS to detect PE in all patients and in patients with high level of clinical suspicion was calculated against the results of the outcome test. PE was diagnosed in 21 patients (35.5%). The sensitivity and specificity of VDS was 33 per cent and 89 per cent, respectively. Among the 28 patients who had a high level of clinical suspicion for PE, the sensitivity of VDS was 23 per cent and the specificity 93 per cent. In this latter population, 1 of the 4 (25%) positive VDS was of a patient without PE and 10 of the 24 (42%) negative VDS were of patients who had PE. VDS does not accurately predict PE in severely injured patients, even in the presence of a high level of clinical suspicion.

scholarly journals Intensive Care Unit Delirium

2016 ◽  
Vol 125 (6) ◽  
pp. 1229-1241 ◽  
Author(s):  
Christina J. Hayhurst ◽  
Pratik P. Pandharipande ◽  
Christopher G. Hughes
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prevention And Treatment ◽  
Intensive Care Unit Delirium

This review examines the most recent evidence for the diagnosis, prevention, and treatment of delirium in the ICU.

scholarly journals The effectiveness and safety of the use of antithrombotic therapy in COVID-19

2021 ◽  
Vol 18 (2) ◽  
pp. 17-30
Author(s):  
K. V. Lobastov ◽  
O. Ya. Porembskay ◽  
I. V. Schastlivtsev
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Increased Risk ◽  
Severe Infections ◽  
Thrombotic Complications ◽  
Risk Of Disease ◽  
Anticoagulant Prophylaxis ◽  
Discharge From Hospital ◽  
Outpatient Settings

The article is a non-systematic review of the literature, addressing the effectiveness, safety and appropriateness of antithrombotic drugs for COVID-19 in patients undergoing treatment in different settings: in the hospital phase, including the intensive care unit, in the outpatient phase after discharge from hospital, in primary outpatient treatment. The issues of thrombotic complications during vaccination and the necessity of their prevention are discussed. The studies confirm the importance of prophylactic doses of anticoagulants in all hospitalized patients. The use of increased doses has proven ineffective in patients with a severe course of the disease who are being treated in the intensive care unit. In moderately severe infections, there is a clear benefit of increased doses of anticoagulants in reducing the risk of organ failure, but definitive conclusions can only be drawn after the final results of the studies have been published. Prolonged pharmacological prophylaxis after hospital discharge may be useful in individual patients, but the overall risk of thrombotic complications in the long-term period does not appear to be high. The available data do not support the use of anticoagulants in the treatment of coronavirus disease in the outpatient settings, since the risk of thrombotic complications is not increased in such patients, and the safety of anticoagulant use has not been evaluated. Sulodexide may be useful in selected outpatients at increased risk of disease progression. Vaccination may provoke the development of atypical localized thrombosis by immune mechanisms, but the risk of such complications is lower in the coronavirus disease itself. Anticoagulant prophylaxis during vaccine administration is not indicated.

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