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High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study

PURPOSE: Little evidence of increased thrombotic risk is available in COVID-19 patients. Our purpose was to assess thrombotic risk in severe forms of SARS-CoV-2 infection. METHODS: All patients referred to 4 intensive care units (ICUs) from two centers of a French tertiary hospital for acute respira...

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Autores principales: Helms, Julie, Tacquard, Charles, Severac, François, Leonard-Lorant, Ian, Ohana, Mickaël, Delabranche, Xavier, Merdji, Hamid, Clere-Jehl, Raphaël, Schenck, Malika, Fagot Gandet, Florence, Fafi-Kremer, Samira, Castelain, Vincent, Schneider, Francis, Grunebaum, Lélia, Anglés-Cano, Eduardo, Sattler, Laurent, Mertes, Paul-Michel, Meziani, Ferhat
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197634/
https://www.ncbi.nlm.nih.gov/pubmed/32367170
http://dx.doi.org/10.1007/s00134-020-06062-x
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author Helms, Julie
Tacquard, Charles
Severac, François
Leonard-Lorant, Ian
Ohana, Mickaël
Delabranche, Xavier
Merdji, Hamid
Clere-Jehl, Raphaël
Schenck, Malika
Fagot Gandet, Florence
Fafi-Kremer, Samira
Castelain, Vincent
Schneider, Francis
Grunebaum, Lélia
Anglés-Cano, Eduardo
Sattler, Laurent
Mertes, Paul-Michel
Meziani, Ferhat
author_facet Helms, Julie
Tacquard, Charles
Severac, François
Leonard-Lorant, Ian
Ohana, Mickaël
Delabranche, Xavier
Merdji, Hamid
Clere-Jehl, Raphaël
Schenck, Malika
Fagot Gandet, Florence
Fafi-Kremer, Samira
Castelain, Vincent
Schneider, Francis
Grunebaum, Lélia
Anglés-Cano, Eduardo
Sattler, Laurent
Mertes, Paul-Michel
Meziani, Ferhat
author_sort Helms, Julie
collection PubMed
description PURPOSE: Little evidence of increased thrombotic risk is available in COVID-19 patients. Our purpose was to assess thrombotic risk in severe forms of SARS-CoV-2 infection. METHODS: All patients referred to 4 intensive care units (ICUs) from two centers of a French tertiary hospital for acute respiratory distress syndrome (ARDS) due to COVID-19 between March 3rd and 31st 2020 were included. Medical history, symptoms, biological data and imaging were prospectively collected. Propensity score matching was performed to analyze the occurrence of thromboembolic events between non-COVID-19 ARDS and COVID-19 ARDS patients. RESULTS: 150 COVID-19 patients were included (122 men, median age 63 [53; 71] years, SAPSII 49 [37; 64] points). Sixty-four clinically relevant thrombotic complications were diagnosed in 150 patients, mainly pulmonary embolisms (16.7%). 28/29 patients (96.6%) receiving continuous renal replacement therapy experienced circuit clotting. Three thrombotic occlusions (in 2 patients) of centrifugal pump occurred in 12 patients (8%) supported by ECMO. Most patients (> 95%) had elevated D-dimer and fibrinogen. No patient developed disseminated intravascular coagulation. Von Willebrand (vWF) activity, vWF antigen and FVIII were considerably increased, and 50/57 tested patients (87.7%) had positive lupus anticoagulant. Comparison with non-COVID-19 ARDS patients (n = 145) confirmed that COVID-19 ARDS patients (n = 77) developed significantly more thrombotic complications, mainly pulmonary embolisms (11.7 vs. 2.1%, p < 0.008). Coagulation parameters significantly differed between the two groups. CONCLUSION: Despite anticoagulation, a high number of patients with ARDS secondary to COVID-19 developed life-threatening thrombotic complications. Higher anticoagulation targets than in usual critically ill patients should therefore probably be suggested. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00134-020-06062-x) contains supplementary material, which is available to authorized users.
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spelling pubmed-71976342020-05-05 High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study Helms, Julie Tacquard, Charles Severac, François Leonard-Lorant, Ian Ohana, Mickaël Delabranche, Xavier Merdji, Hamid Clere-Jehl, Raphaël Schenck, Malika Fagot Gandet, Florence Fafi-Kremer, Samira Castelain, Vincent Schneider, Francis Grunebaum, Lélia Anglés-Cano, Eduardo Sattler, Laurent Mertes, Paul-Michel Meziani, Ferhat Intensive Care Med Original PURPOSE: Little evidence of increased thrombotic risk is available in COVID-19 patients. Our purpose was to assess thrombotic risk in severe forms of SARS-CoV-2 infection. METHODS: All patients referred to 4 intensive care units (ICUs) from two centers of a French tertiary hospital for acute respiratory distress syndrome (ARDS) due to COVID-19 between March 3rd and 31st 2020 were included. Medical history, symptoms, biological data and imaging were prospectively collected. Propensity score matching was performed to analyze the occurrence of thromboembolic events between non-COVID-19 ARDS and COVID-19 ARDS patients. RESULTS: 150 COVID-19 patients were included (122 men, median age 63 [53; 71] years, SAPSII 49 [37; 64] points). Sixty-four clinically relevant thrombotic complications were diagnosed in 150 patients, mainly pulmonary embolisms (16.7%). 28/29 patients (96.6%) receiving continuous renal replacement therapy experienced circuit clotting. Three thrombotic occlusions (in 2 patients) of centrifugal pump occurred in 12 patients (8%) supported by ECMO. Most patients (> 95%) had elevated D-dimer and fibrinogen. No patient developed disseminated intravascular coagulation. Von Willebrand (vWF) activity, vWF antigen and FVIII were considerably increased, and 50/57 tested patients (87.7%) had positive lupus anticoagulant. Comparison with non-COVID-19 ARDS patients (n = 145) confirmed that COVID-19 ARDS patients (n = 77) developed significantly more thrombotic complications, mainly pulmonary embolisms (11.7 vs. 2.1%, p < 0.008). Coagulation parameters significantly differed between the two groups. CONCLUSION: Despite anticoagulation, a high number of patients with ARDS secondary to COVID-19 developed life-threatening thrombotic complications. Higher anticoagulation targets than in usual critically ill patients should therefore probably be suggested. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00134-020-06062-x) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2020-05-04 2020 /pmc/articles/PMC7197634/ /pubmed/32367170 http://dx.doi.org/10.1007/s00134-020-06062-x Text en © Springer-Verlag GmbH Germany, part of Springer Nature 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original
Helms, Julie
Tacquard, Charles
Severac, François
Leonard-Lorant, Ian
Ohana, Mickaël
Delabranche, Xavier
Merdji, Hamid
Clere-Jehl, Raphaël
Schenck, Malika
Fagot Gandet, Florence
Fafi-Kremer, Samira
Castelain, Vincent
Schneider, Francis
Grunebaum, Lélia
Anglés-Cano, Eduardo
Sattler, Laurent
Mertes, Paul-Michel
Meziani, Ferhat
High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study
title High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study
title_full High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study
title_fullStr High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study
title_full_unstemmed High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study
title_short High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study
title_sort high risk of thrombosis in patients with severe sars-cov-2 infection: a multicenter prospective cohort study
topic Original
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197634/
https://www.ncbi.nlm.nih.gov/pubmed/32367170
http://dx.doi.org/10.1007/s00134-020-06062-x
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