Thromboembolic and bleeding events in ICU patients with COVID-19: results from a Brazilian tertiary hospital

Brandão, Antonio Adolfo Guerra Soares; de Oliveira, Cleyton Zanardo; Rojas, Salomon Ordinola; Ordinola, Amanda Ayako Minemura; Queiroz, Victoria Masi; de Farias, Danielle Leão Cordeiro; Scheinberg, Phillip; Veiga, Viviane Cordeiro

Objectives: Describe the incidence of thromboembolic events in adult patients with severe COVID-19 and identify clinical and laboratory correlates factors associated with these events. Design: Observational retrospective cohort of 243 adult patients with severe COVID-19 who were admitted to an intensive care unit at a Brazilian tertiary hospital. Results: The incidence of all thromboembolic events was 14.8%, in which 3.8% developed deep vein thrombosis, 7.8% pulmonary embolism, 2.5% acute myocardial infarction, 1.2% stroke, and 1.2% peripheral artery occlusion. Risk factors identified were D-dimer at admission higher than 3,000 ng/mL (p=<0.0013) and major bleeding (p=0.001). The cumulative risk of developing thromboembolic events at day 28 after ICU admission was 16.0%. The rate of major bleeding was 4.1%. After ROC curve analysis, the D-dimer cut-off at admission that correlated with thromboembolic events was 1,140.5 ng/mL. Conclusions: The rate of thromboembolic events in our study was lower than previously described. High D-dimer levels at admission was the leading risk factor and the optimal cut-off was 1,140.5 ng/mL. The occurrence of thromboembolic events did not have an impact on the median overall survival. The optimal anticoagulant strategy in this context still needs to be established.