CHEST Guidelines-VTE-in-ICU-Patients-With-COVID-19_2020

VTE-in-ICU-Patients-With-COVID-19_2020_chest

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In the study "VTE in ICU Patients With COVID-19" published in the journal CHEST, researchers explored the incidence of venous thromboembolism (VTE) in ICU patients with COVID-19, despite the administration of standard prophylactic anticoagulation. The study evaluated data from 210 COVID-19 positive patients admitted to Brigham and Women’s Hospital from March 7 to April 13, 2020. <br /><br />Researchers found that ICU patients possessed a distinctive hyperinflammatory procoagulant phenotype, characterized by elevated inflammatory and coagulation markers such as fibrinogen, D-dimer, LDH, ferritin, and CRP. Of the 210 patients, 190 received anticoagulation at admission, and symptomatic VTE events occurred in nine patients, most while on prophylactic anticoagulation. The study reported a 14-day cumulative incidence of radiographically confirmed VTE at 9.3% for ICU patients, significantly higher compared to ward patients. No VTE events occurred in ward patients.<br /><br />This study highlights a critical finding: standard VTE prophylaxis, which uses medications like enoxaparin or unfractionated heparin, might be inadequate for ICU patients with COVID-19. ICU patients exhibit increased VTE incidence due to their specific inflammatory responses and the nature of critical illness, suggesting a need for alternative strategies or dosages in VTE prophylaxis for these patients.<br /><br />Furthermore, the data suggest that the profound inflammatory response to SARS-CoV-2 could lead to early VTE events when ICU care is required, while prolonged ICU stays could increase later VTE risk. Although elevated aPTT was associated with CRP levels, it did not predict VTE events, reinforcing that underlying inflammation and coagulation dysregulation in COVID-19 significantly affect VTE risk and management.<br /><br />The study calls for further investigation into optimal anticoagulation strategies specifically tailored for critically ill COVID-19 ICU patients to effectively manage and reduce VTE risks.

Keywords

VTE

ICU

COVID-19

anticoagulation

inflammatory markers

prophylaxis

SARS-CoV-2

hyperinflammatory

Brigham and Women’s Hospital

coagulation dysregulation