Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Anaesthesiology, Zealand University Hospital, Roskilde, Denmark.
Acta Anaesthesiol Scand. 2023 Jan;67(1):76-85. doi: 10.1111/aas.14157. Epub 2022 Nov 6.
Intensive care unit (ICU) patients with Coronavirus disease 2019 (COVID-19) have an increased risk of thromboembolic complications. We describe the occurrence of thromboembolic and bleeding events in all ICU patients with COVID-19 in Denmark during the first and second waves of the pandemic.
This was a sub-study of the Danish Intensive Care Covid database, in which all patients with SARS-CoV-2 admitted to Danish ICUs from 10th March 2020 to 30th June 2021 were included. We registered coagulation variables at admission, and all thromboembolic and bleeding events, and the use of heparins during ICU stay. Variables associated with thrombosis and bleeding and any association with 90-day mortality were estimated using Cox regression analyses.
We included 1369 patients in this sub-study; 158 (12%, 95% confidence interval 10-13) had a thromboembolic event in ICU and 309 (23%, 20-25) had a bleeding event, among whom 81 patients (6%, 4.8-7.3) had major bleeding. We found that mechanical ventilation and increased D-dimer were associated with thrombosis and mechanical ventilation, low platelet count and presence of haematological malignancy were associated with bleeding. Most patients (76%) received increased doses of thromboprophylaxis during their ICU stay. Thromboembolic events were not associated with mortality in adjusted analysis (hazard ratio 1.35 [0.91-2.01, p = .14], whereas bleeding events were 1.55 [1.18-2.05, p = .002]).
Both thromboembolic and bleeding events frequently occurred in ICU patients with COVID-19. Based on these data, it is not apparent that increased doses of thromboprophylaxis were beneficial.
患有 2019 年冠状病毒病（COVID-19）的重症监护病房（ICU）患者发生血栓栓塞并发症的风险增加。我们描述了丹麦在 COVID-19 大流行的第一波和第二波期间所有 ICU 患者中血栓栓塞和出血事件的发生情况。
这是丹麦重症监护 COVID 数据库的一项子研究，其中纳入了 2020 年 3 月 10 日至 2021 年 6 月 30 日期间丹麦 ICU 收治的所有 SARS-CoV-2 患者。我们记录了入院时的凝血变量，以及 ICU 期间所有的血栓栓塞和出血事件以及肝素的使用情况。使用 Cox 回归分析估计与血栓形成和出血相关的变量以及与 90 天死亡率的任何关联。
本子研究共纳入 1369 例患者；158 例（12%，95%置信区间 10-13）在 ICU 发生血栓栓塞事件，309 例（23%，20-25）发生出血事件，其中 81 例（6%，4.8-7.3）发生大出血。我们发现机械通气和 D-二聚体增加与血栓形成有关，机械通气、血小板计数降低和血液恶性肿瘤与出血有关。大多数患者（76%）在 ICU 期间接受了增加剂量的血栓预防治疗。在调整分析中，血栓栓塞事件与死亡率无关（危险比 1.35 [0.91-2.01，p=0.14]，而出血事件为 1.55 [1.18-2.05，p=0.002]）。
COVID-19 重症监护病房患者经常发生血栓栓塞和出血事件。根据这些数据，增加剂量的血栓预防治疗似乎没有益处。
