University of Hertfordshire Research Archive

        JavaScript is disabled for your browser. Some features of this site may not work without it.

        Browse

        All of UHRABy Issue DateAuthorsTitlesThis CollectionBy Issue DateAuthorsTitles

        Arkivum Files

        My Downloads
        View Item 
        • UHRA Home
        • University of Hertfordshire
        • Research publications
        • View Item
        • UHRA Home
        • University of Hertfordshire
        • Research publications
        • View Item

        Prevalence of Thrombotic Complications in ICU-Treated Patients With Coronavirus Disease 2019 Detected With Systematic CT Scanning

        View/Open
        Final Accepted Version (PDF, 388Kb)
        Author
        Mirsadraee, Saeed
        Gorog, Diana
        Mahon, CF
        Rawal, B
        Semple, TR
        Nicol, Ed
        Arachchillage, Deepa RJ
        Devaraj, A
        S, Price
        Desai, SR
        Ridge, CA
        Singh, S
        Padley, SPG
        Attention
        2299/23757
        Abstract
        Objective: Severe Coronavirus disease 2019 (COVID-19) is associated with an extensive pneumonitis, and frequent coagulopathy. We sought the true incidence of thrombotic complications in critically ill patients with severe COVID-19 on the intensive care unit (ICU), with or without extracorporeal membrane oxygenation (ECMO). Design: We undertook a single-centre, retrospective analysis of 72 critically ill patients with COVID-19 associated acute respiratory distress syndrome admitted to ICU. CT angiography of the thorax, abdomen and pelvis were performed on admission as per routine institution protocols, with further imaging as clinically indicated. The prevalence of thrombotic complications and the relationship with coagulation parameters, other biomarkers and survival were evaluated.. Setting: COVID-19 ICUs at a specialist cardiorespiratory centre. Patients: Seventy two consecutive patients with COVID-19 admitted to ICU during the study period (19/03/2020-23/06/2020). Interventions: None. Measurements and Main Results: All but one patient received thromboprophylaxis or therapeutic anticoagulation. Amongst 72 patients (M:F=74%; mean age: 52+10; 35 on ECMO), there were 54 thrombotic complications in 42 patients (58%), comprising 34 pulmonary arterial (47%), 15 peripheral venous (21%), and 5 (7%) systemic arterial thromboses / end-organ embolic complications. In those with pulmonary arterial thromboses, 93% were identified incidentally on first screening CT with only 7% suspected clinically. Biomarkers of coagulation (eg. D-dimer, Fibrinogen level, APTT) or inflammation (white cell count, CRP), did not discriminate between patients with or without thrombotic complications. Fifty-one patients (76%) survived to discharge; 17 (24%) patients died. Mortality was significantly greater in patients with detectable thrombus (33% vs. 10%, p=0.022). Conclusions: There is a high incidence of thrombotic complications, mainly pulmonary, amongst COVID-19 patients admitted to ICU, despite anticoagulation. Detection of thrombus was usually incidental, not predicted by coagulation or inflammatory biomarkers, and associated with increased risk of death. Systematic CT imaging at admission should be considered in all COVID-19 patients requiring ICU.
        Publication date
        2021-01-06
        Published in
        Critical Care Medicine
        Published version
        https://doi.org/10.1097/CCM.0000000000004890
        License
        Other
        Other links
        http://hdl.handle.net/2299/23757
        Relations
        School of Life and Medical Sciences
        Metadata
        Show full item record
        Keep in touch

        © 2019 University of Hertfordshire

        I want to...

        • Apply for a course
        • Download a Prospectus
        • Find a job at the University
        • Make a complaint
        • Contact the Press Office

        Go to...

        • Accommodation booking
        • Your student record
        • Bayfordbury
        • KASPAR
        • UH Arts

        The small print

        • Terms of use
        • Privacy and cookies
        • Criminal Finances Act 2017
        • Modern Slavery Act 2015
        • Sitemap

        Find/Contact us

        • T: +44 (0)1707 284000
        • E: ask@herts.ac.uk
        • Where to find us
        • Parking
        • hr
        • qaa
        • stonewall
        • AMBA
        • ECU Race Charter
        • disability confident
        • AthenaSwan