• F A Klok, Kruip M J H A MJHA Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands., van der Meer N J M NJM Department of Anesthesiology and Critical Care, Amphia Hospital Breda, Oosterhout, the Netherlands; TIAS/Tilburg University Tilburg, the Netherland, M S Arbous, D Gommers, K M Kant, F H J Kaptein, J van Paassen, M A M Stals, M V Huisman, and H Endeman.
• Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: f.a.klok@LUMC.nl.
• Thromb. Res. 2020 Jul 1; 191: 148-150.

IntroductionWe 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.MethodsWe 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.ResultsWe 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).ConclusionIn this updated analysis, we confirm the very high cumulative incidence of thrombotic complications in critically ill patients with COVID-19 pneumonia.Copyright © 2020. Published by Elsevier Ltd.

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