Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis

Thromb Res. 2020 Jul:191:148-150. doi: 10.1016/j.thromres.2020.04.041. Epub 2020 Apr 30.


Introduction: We recently reported a high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 admitted to the intensive care units (ICUs) of three Dutch hospitals. In answering questions raised regarding our study, we updated our database and repeated all analyses.

Methods: We re-evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction and/or systemic arterial embolism in all COVID-19 patients admitted to the ICUs of 2 Dutch university hospitals and 1 Dutch teaching hospital from ICU admission to death, ICU discharge or April 22nd 2020, whichever came first.

Results: We studied the same 184 ICU patients as reported on previously, of whom a total of 41 died (22%) and 78 were discharged alive (43%). The median follow-up duration increased from 7 to 14 days. All patients received pharmacological thromboprophylaxis. The cumulative incidence of the composite outcome, adjusted for competing risk of death, was 49% (95% confidence interval [CI] 41-57%). The majority of thrombotic events were PE (65/75; 87%). In the competing risk model, chronic anticoagulation therapy at admission was associated with a lower risk of the composite outcome (Hazard Ratio [HR] 0.29, 95%CI 0.091-0.92). Patients diagnosed with thrombotic complications were at higher risk of all-cause death (HR 5.4; 95%CI 2.4-12). Use of therapeutic anticoagulation was not associated with all-cause death (HR 0.79, 95%CI 0.35-1.8).

Conclusion: In this updated analysis, we confirm the very high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 pneumonia.

Keywords: COVID-19; Deep vein thrombosis; Pulmonary embolism; Stroke; Venous thromboembolism.

MeSH terms

  • Acute Disease
  • Anticoagulants / therapeutic use
  • Arterial Occlusive Diseases / epidemiology*
  • Arterial Occlusive Diseases / etiology
  • Brain Ischemia / epidemiology
  • Brain Ischemia / etiology
  • COVID-19
  • Coronavirus Infections / complications*
  • Critical Illness
  • Embolism / epidemiology
  • Embolism / etiology
  • Female
  • Follow-Up Studies
  • Hospitals, Teaching / statistics & numerical data
  • Hospitals, University / statistics & numerical data
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / etiology
  • Netherlands / epidemiology
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pulmonary Embolism / epidemiology*
  • Pulmonary Embolism / etiology
  • Thrombophilia / drug therapy
  • Thrombophilia / etiology*
  • Venous Thrombosis / epidemiology*
  • Venous Thrombosis / etiology


  • Anticoagulants