Incidence and effects of deep vein thrombosis on the outcome of patients with coronavirus disease 2019 infection

Investigation on the Implementation of Mechanical Prophylaxis Procedures for Deep Venous Thrombosis in ICU in Southwest China: A Cross-Sectional Study

INTRODUCTION

For ICU patients at high risk of bleeding or those already bleeding, it is recommended to use mechanical prophylaxis methods such as intermittent pneumatic compression (IPC), graduated compression stockings (GCS), or a venous foot pump (VFP).

OBJECTIVE

This work aims to examine the implementation of mechanical prophylaxis measures for DVT in ICUs in Southwest China and provide a foundation for improving their adoption and effectiveness.

METHOD

In this study, a questionnaire developed by the researchers, based on existing literature, was used as the data collection tool. Following ethical approval, data were collected through self-administered questionnaires from 780 ICU nurses across 124 ICUs in Southwest China, between August and December 2022. Of these, 67.7% (84/124) were from Grade III hospitals, and 32.3% (40/124) were from Grade II hospitals. Additionally, 66.5% (519/780) of nurses had received training on DVT prophylaxis knowledge, whereas 33.5% (261/780) had not. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 21.0, with descriptive statistics and Pearson chi-square tests applied for analysis.

RESULTS

Statistically significant differences were observed among hospitals of different grades in several aspects, including the professional management team, dynamic assessments, risk assessment records, bedside warning signs, and implement sign-in communication for high-risk patients (p < 0.05). Statistically significant differences were also found between nurses who had received training on DVT prevention and those who had not, in terms of excluding related contraindications, conducting monthly inspections and preventive maintenance, having a specially assigned person for management, and providing clear precautions (p < 0.05). All ICUs were equipped with at least one type of mechanical prophylaxis equipment, but the proportion and duration of equipment use varied between hospitals. The top three factors hindering the implementation of mechanical prophylaxis were insufficient equipment, inadequate human resources, and failure to reset equipment in a timely manner after disuse.

CONCLUSION

Hospital grade, DVT prevention training, resource allocation for mechanical prophylaxis, and the implementation of prophylactic measures all influence the management of DVT mechanical prophylaxis in ICU patients. Moving forward, personalized DVT mechanical prophylaxis strategies should be tailored to the specific characteristics and needs of hospitals at different levels, with a focus on strengthening the establishment of systems, enhancing nurse training, improving equipment availability, and increasing equipment usage duration to improve the overall effectiveness of DVT prevention management.

Clinical characteristics of COVID-19 associated vasculopathic diseases

Coronavirus disease 19 (COVID-19) has shown to be an infectious disease affecting not only of the respiratory system, but also cardiovascular system leading to different COVID-19-associated vasculopathies. Venous and arterial thromboembolic events have been frequently described among hospitalized patients with COVID-19 and inflammatory vasculopathic changes have also been observed. Several of the reported COVID-19 associated vasculopathies exhibit differences on epidemiology, clinical characteristics and outcome compared to non-COVID-19 types. This review focuses on the epidemiology, clinical, diagnostic and therapeutic characteristics as well as outcome data of COVID-19 associated thromboembolic events and inflammatory vasculopathies, elaborating similarities and differences with non-COVID-19 cohorts.

COVID-19 Related Thrombotic Complications Experience Before and During Delta Wave

OBJECTIVE

Hypercoagulability and thrombotic complications seen in SARS-CoV-2 patients, as well as the associated pathophysiology, have been reported extensively. However, there is limited information regarding the factors related to this phenomenon and its association with the COVID-19 delta variant.

METHODS

A retrospective review including patients admitted to a tertiary center with a COVID-19 positive test and at least one acute thrombotic event confirmed by imaging between June 2020 and August 2021 was performed. We compared the rates of thrombotic events in patients with COVID-19 before and during the Delta peak. We also analyzed the association of the thrombotic complications with demographic characteristics, comorbidities, anticoagulation strategies, and prothrombotic markers while describing other complications secondary to COVID-19 infection.

RESULTS

Out of 964 patients admitted with COVID-19 diagnosis, 26.5% (n=256) had a thrombotic event evidenced by ultrasound (US) or computerized tomography (CT) scan. Venous thromboembolism was found in 60% (n=153), arterial thrombosis in 23% (n=60), and both venous and arterial thromboses in 17% (n=17) of the study cohort. Of all patients, 94% were not vaccinated. Delta variant wave patients (DW) had thrombotic episodes in 34.7% (n=50/144) of cases compared to 25% (n=206/820) of non-Delta wave (NDW) patients, posing an estimated risk 1.36 times higher in patients infected with COVID-19 during the DW than NDW. Overall, DW subjects were significantly younger (p<0.001) with lower BMI (p=0.021) compared to NDW patients. Statistical analyses showed African American patients were more likely to have arterial thrombosis compared to the other groups when testing positive for COVID-19 (OR: 1.78 [CI: 1.04 - 3.05], p=0.035), whereas immunosuppressed patients had less risk of arterial thrombosis (OR: 0.38 [CI: 0.15 - 0.96], p=0.042). Female gender (OR: 2.15 [CI: 1.20 - 3.85]. p=0.009) and patients with active malignancy (OR: 5.99 [CI: 2.14 - 16.78]. p=0.001) had an increased risk of having multiple thrombotic events at different locations secondary to COVID-19.

CONCLUSION

COVID-19 infection is associated with elevated rates of thrombotic complications and an especially higher risk in patients infected during the Delta variant peak. We highlight the importance of vaccination and the development of new anticoagulation strategies for COVID-19 patients with additional hypercoagulable risk factors to prevent thrombotic complications caused by this disease.