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

Autor: Vincent Castelain, Malika Schenck, Samira Fafi-Kremer, François Severac, Xavier Delabranche, Laurent Sattler, Raphaël Clere-Jehl, Julie Helms, Hamid Merdji, Eduardo Anglés-Cano, Charles Tacquard, Francis Schneider, Ian Leonard-Lorant, Lelia Grunebaum, Paul-Michel Mertes, Mickaël Ohana, Ferhat Meziani, Florence Fagot Gandet
Přispěvatelé: Service de Médecine Intensive et Réanimation [Strasbourg], CHU Strasbourg, Immuno-Rhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Strasbourg (UNISTRA), Service d'Anesthésie-Réanimation [Strasbourg], Nouvel Hôpital Civil [Strasbourg], CHU Strasbourg-CHU Strasbourg, Groupe Méthodes en Recherche Clinique [Strasbourg] (GMRC), Radiology Department [Strasbourg], Regenerative NanoMedicine [Strasbourg] (RNM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA)-Université de Strasbourg (UNISTRA), CHU Strasbourg-Hôpital de Hautepierre [Strasbourg], Laboratoire de Virologie Médicale [Strasbourg], Laboratoire d'Hématologie [Strasbourg], Innovations thérapeutiques en hémostase (IThEM - U1140), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis, Bodescot, Myriam, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)
Rok vydání: 2020
Předmět:
ARDS
medicine.medical_specialty
medicine.medical_treatment
Critical Care and Intensive Care Medicine
03 medical and health sciences
0302 clinical medicine
[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Coagulopathy
Intensive care
Internal medicine
medicine
Renal replacement therapy
Prospective cohort study
[SDV.MP.VIR] Life Sciences [q-bio]/Microbiology and Parasitology/Virology
[SDV.MHEP.ME] Life Sciences [q-bio]/Human health and pathology/Emerging diseases
Disseminated intravascular coagulation
[SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases
Lupus anticoagulant
business.industry
COVID-19
Thrombosis
030208 emergency & critical care medicine
medicine.disease
[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
3. Good health
030228 respiratory system
[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie
[SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
business
Zdroj: Intensive Care Medicine
Intensive Care Medicine, Springer Verlag, 2020, ⟨10.1007/s00134-020-06062-x⟩
Intensive Care Medicine, 2020, ⟨10.1007/s00134-020-06062-x⟩
ISSN: 1432-1238
0342-4642
Popis: International audience; 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
Databáze: OpenAIRE
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