COVID-19 associated thrombotic complications and solutions Menno - - PowerPoint PPT Presentation

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Dec 20, 2023 361 likes •551 views

COVID-19 associated thrombotic complications and solutions Menno Huisman MD PhD FESC Department of Thrombosis and Hemostasis Leiden University Medical Center the Netherlands m.v.huisman@lumc.nl Nederland in de top drie COVID-19 coagulopathy

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COVID-19 associated thrombotic complications and solutions

Menno Huisman MD PhD FESC Department of Thrombosis and Hemostasis Leiden University Medical Center the Netherlands  m.v.huisman@lumc.nl

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Nederland in de top drie

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COVID-19 coagulopathy

Iba T et al, 2020

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COVID-19 associated VTE: initial reports

Geen woord

ver trombose

(ook niet over het hart, wel

ver diabetes)

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COVID-19 coagulopathy must give events

Zhou F et al, Lancet 2020

+

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Our Dutch experience; 10 April 2020 online

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Dutch experience

✓ 184 ICU patients with proven COVID-19 pneumonia ✓ All received LMWH thromboprophylaxis in different doses

✓ Diagnostic tests in case of suspected thrombotic complications ✓ At risk period from moment of admission to death, discharge from ICU or censoring at April 7th and April 14th 2020 respectively

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First analysis

✓ Cumulative incidence 31% (95% BI 20-41)

➢ VTE: 27% (95%BI 17-37%) ➢ Ischemic stroke: 3.7% (95%BI 0-8.2%)

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COVID-IC study

✓ Cumulative incidence in competing risk model: 49% (95%CI 41-57) ➢ Acute PE overall majority – 87% ➢ Ischemic stroke – 6 % ➢ Thrombotic complications strongly predictive

f mortality: adjusted HR 5.4; 95%CI 2.4-12

Klok FA, et al. Thrombosis Research 2020; 191: 148–150 Helms J et al. Intensive Care Medicine 2020; 46:1089–1098 Middeldorp S et al. J Thromb Haemost 2020; doi: 10.1111/JTH.14888

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Pulmonary emboli: from leg veins or in situ Stroke: PFO; locally formed ‘immuno-thrombosis’

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Thrombosis and COVID solution: prevention!

Give LMWH prophylaxis to all hospitalized patients with COVID-19

ICU patients: intermediate prophylactic dose

Enoxaparin 40mg OD to 80 mg OD
If weight ≥ 100 kgf double the dose again
Increased bleeding risk (e.g. thrombocytopenia < 30 x109/L) stay with

standard thromboprophylaxis (e.g. enoxaparin 40 mg OD)

E-GFR < 30 ml/min: standard thromboprophylaxis or doubling with anti-Xa

activity monitoring

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VTE in COVID: treatment

Provoked VTE - 3 months is enough

ICU -ward

→

LMWH/UFH

✓

Ward at home

→

LMWH

✓

DOAC

✓

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Doen het hart en diabetes niet mee?

Garibaldi et al. Patient Trajectories Among Persons Hospitalized for COVID-19. Ann Int Med 2020 online

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Doen hart en diabetes niet mee?

Puntmann et al JAMA Cardiology 2020

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Conclusions and remaining questions

✓ Thrombotic complications frequent at ICU – less so at wards – home? ✓ (Doubled) intermediate thromboprophylaxis indicated may be not enough to prevent thrombosis to occur

✓ Diagnostic tests in case of suspected thrombotic complications - or screen? ✓ Strokes are surprising and enigmatic – PFO likely responsible for some

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Dutch COVID & Thrombosis Coalition

Dutch COVID & Thrombosis Coalition, RPTH 2020

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