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Observational Study
. 2021 Dec:113:236-242.
doi: 10.1016/j.ijid.2021.10.020. Epub 2021 Oct 17.

Thromboembolic and bleeding events in intensive care unit patients with COVID-19: results from a Brazilian tertiary hospital

Antonio Adolfo Guerra Soares Brandão  1 , Cleyton Zanardo de Oliveira  2 , Salomon Ordinola Rojas  2 , Amanda Ayako Minemura Ordinola  2 , Victoria Masi Queiroz  2 , Danielle Leão Cordeiro de Farias  2 , Phillip Scheinberg  2 , Viviane Cordeiro Veiga  3
Affiliations
Observational Study

Thromboembolic and bleeding events in intensive care unit patients with COVID-19: results from a Brazilian tertiary hospital

Antonio Adolfo Guerra Soares Brandão et al. Int J Infect Dis. 2021 Dec.

Abstract

Objectives: To describe the incidence of thromboembolic events in adult patients with severe COVID-19 and identify clinical and laboratory factors associated with these events.

Design: Observational retrospective cohort study of 243 adult patients with severe COVID-19 admitted to an intensive care unit (ICU) at a Brazilian tertiary hospital.

Results: The incidence of all thromboembolic events was 14.8%, in which 3.8% developed deep vein thrombosis, 7.8% pulmonary embolism, 2.5% acute myocardial infarction, 1.2% stroke, and 1.2% peripheral artery occlusion. Risk factors identified were D-dimer at admission >3000 ng/mL (P=<0.0013) and major bleeding (P=0.001). The cumulative risk of developing thromboembolic events at day 28 after ICU admission was 16.0%. The rate of major bleeding was 4.1%. After receiver operating characteristic curve analysis, the D-dimer cut-off at admission correlating with thromboembolic events was 1140.5 ng/mL.

Conclusions: The rate of thromboembolic events in our study was lower than previously described. High D-dimer level at admission was the leading risk factor; the optimal cut-off was 1140.5 ng/mL. The occurrence of thromboembolic events did not have an impact on the median overall survival rate. The optimal anticoagulant strategy in this context still needs to be established.

Keywords: COVID-19; D-dimer; intensive care unit; survival; thrombosis.

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Conflict of interest statement

Declaration of Competing Interests Nothing to disclose.

Figures

Figure 1
Figure 1
Cumulative risk of thromboembolic events until 28 days after intensive care unit admission.
Figure 2
Figure 2
Receiver operating characteristic (ROC) curve of D-dimer levels at admission higher than 1140 ng/mL and occurrence of thromboembolic events.
Figure 3
Figure 3
Evolution of D-dimer levels during follow-up in different moments after intensive care unit admission.
Figure 4
Figure 4
Overall survival by Kaplan-Meier analysis in all patients (A) and according to D-dimer levels higher or lower than 1140.5 ng/mL (B) (P=<0.001). Hazard ratio = 4.09 (95% CI 2.47–6.78).
See this image and copyright information in PMC

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