Incidence of Thromboembolism in COVID-19 Patients in Intensive Care Units: A Retrospective Cohort Analysis

Ayse Z Turan Civraz; Ipek Duzyol; Emine Atli; Cigdem Caglayan; Emine Ozer Yurt; Adnan Ata; Mehmet Yilmaz; Berna Karakoyun

doi:10.7759/cureus.47014

Incidence of Thromboembolism in COVID-19 Patients in Intensive Care Units: A Retrospective Cohort Analysis

Cureus. 2023 Oct 14;15(10):e47014. doi: 10.7759/cureus.47014. eCollection 2023 Oct.

Authors

Ayse Z Turan Civraz¹, Ipek Duzyol¹, Emine Atli¹, Cigdem Caglayan¹, Emine Ozer Yurt¹, Adnan Ata¹, Mehmet Yilmaz¹, Berna Karakoyun²

Affiliations

¹ Department of Anesthesiology and Reanimation, Kocaeli City Hospital, Kocaeli, TUR.
² Department of Physiology, University of Health Sciences, Hamidiye Faculty of Medicine, Istanbul, TUR.

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) infection was declared a pandemic, causing high mortality and morbidity worldwide. It predisposes patients to both arterial and venous thromboembolism, which causes high mortality, and is one of the most serious complications of the disease.

Objective: The aim of this retrospective study was to determine the frequency of thromboembolic events in patients diagnosed with COVID-19 in the intensive care unit (ICU) and to identify the factors causing thromboembolism.

Material and methods: The digital records of patients admitted to the adult ICU of Derince Training and Research Hospital, Kocaeli, Turkey, with a diagnosis of COVID-19 between March 13, 2020, and December 31, 2021, were retrospectively reviewed.

Results: Data of 484 patients, 248 (51.2%) female and 236 (48.8%) male, aged between 18-98 years were analyzed. The overall, arterial and venous incidence of thromboembolism was 14.8%, 11.3%, and 3.5%, respectively. There was no significant association between COVID-19 variants and the development of thromboembolism. The effect of various patient variables on the development of thromboembolism was evaluated, including cardiovascular disease (p<0.001), age (p=0.003), use of acetylsalicylic acid (ASA) (p<0.001), antiplatelet therapy (p<0. 001), acute physiology and chronic health evaluation (APACHE) II score (p=0.003), D-dimer (p=0.015), fibrinogen (p=0.032), ferritin (p=0.015), prothrombin time (PT) (p=0.015), international normalized ratio (INR) (p=0.012), troponin (p=0.012) values at the ICU admission were found statistically significant. The cut-off values were 2.565 (μg/mL) for D-dimer, 435.51 (mg) for fibrinogen, 633.55 (ml/ng) for ferritin, 1.155 for INR, and 0.085 (ng/mL) for troponin.

Conclusion: Although low-molecular-weight heparin (LMWH) is the first choice, it may be appropriate to add ASA and other antiplatelet agents to reduce the risk of thromboembolism in patients with high thromboembolic risk including advanced age, cardiovascular disease, and elevated levels of D-dimer, troponin, ferritin, and fibrinogen.

Keywords: arterial thromboembolism; coronavirus disease 2019 (covid-19); covid-19 associated coagulopathy; covid-19 induced thromboembolism; variants of covid-19; venous thromboembolism (vte).