29 May COVID-19: Venous Thrombosis Among Critically Ill Patients
MedicalResearch.com Interview with:
Dr Tristan Morichau-Beauchant, MD.
Intensive Care Unit
Centre Cardiologique du Nord
MedicalResearch.com: What is the background for this study?
Response: During the spread of the COVID-19 epidemic in France, early reports on severe patients stated a highly increased inflammatory response associated with procoagulant changes in coagulation pathways and high D-Dimer levels. Preliminary reports from the intensive care community signaled frequent events of deep vein thrombosis (DVT) among this population. We decided to perform prospectively a venous ultrasonogram of the inferior limbs for all patients with severe COVID-19 pneumonia at admission in our ICU. All patients had acute respiratory distress syndrome according to the Berlin definition an required mechanical ventilation. Considering the high prevalence of venous thrombosis at admission we repeated a venous ultrasonography after 48 hours if the first exam was normal. All patients received standard anticoagulant prophylaxis since hospital admission.
MedicalResearch.com: What are the main findings?
Response: The results showed a high proportion of DVT at admission. A total of 34 consecutive patients were assessed and 22 patients (65 %) had DVT at admission. Interestingly, despite anticoagulant prophylaxis, five patients (15 %) acquired DVT in the first 48 hours after ICU admission for a total of 27 patients (79 %) with DVT 48 hours after ICU admission. Nine patients (26 %) had proximal thrombosis and 18 patients (53%) had bilateral thrombosis. Our population had high levels of D-Dimer (mean 5.1µg/mL).
MedicalResearch.com: What should readers take away from your report?
Response: Deep vein thrombosis seems frequent among severe patients with COVID-19 pneumonia and anticoagulant prophylaxis at standard dosage might not be sufficient to prevent the occurrence of DVT. Systematic assessment of DVT with venous ultrasonogram should be recommended for this population.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: In view of these results and other studies reporting a high rate of DVT as well as other venous and arterial thrombotic events such as pulmonary embolism, systematic anticoagulant therapy for all ICU patients with COVID-19 should be assessed in a randomized trial.
MedicalResearch.com: Is there anything else you would like to add?
Response: Current guidelines regarding anticoagulant prophylaxis for patients with COVID-19 pneumonia are heterogenous, recommending at least standard anticoagulant prophylaxis. Intermediate doses and full dose anticoagulant therapy have been empirically recommended in some guidelines for more severe patients or patients with high levels of D-Dimers in view of limited retrospective data. Hopefully upcoming trials will allow to design anticoagulant algorithms for COVID-19 patients based on more solid data.
I have no disclosure regarding this publication
Nahum J, Morichau-Beauchant T, Daviaud F, et al. Venous Thrombosis Among Critically Ill Patients With Coronavirus Disease 2019 (COVID-19). JAMA Netw Open. 2020;3(5):e2010478. doi:10.1001/jamanetworkopen.2020.10478
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