The Prevalence of Thromboembolic Events Among COVID-19 Patients Admitted to a Single Centre Intensive Care Unit (ICU): an Epidemiological Study from a Malaysian Population

Overview

Journal J Pharm Policy Pract

Date 2025 Feb 7

PMID 39917475

Authors

Nur Farhani Mansor

Izzati Abdul Halim Zaki

Lee Chew Kiok

Eng Kar Seng

Tharmini Ravi

Mohan Pathmanathan

Khang Wen Goh

Long Chiau Ming

Pakhrur Razi

Hanis Hanum Zulkifly

Affiliations

Soon will be listed here.

Abstract

Introduction: Thromboembolic (TE) complications in COVID-19 patients are rising globally, contributing significantly to mortality, particularly in severe cases. However, their prevalence, characteristics, and impact on mortality in Malaysia remain unclear.

Objectives: This study aimed to determine the prevalence of thromboembolic (TE) events and associated mortality among COVID-19 patients admitted within a single centre intensive care unit (ICU). The proportions of patients with TE events who died, and factors associated with TE events were explored.

Methods: In this retrospective cohort study, patients with PCR confirmed SARS-CoV-2 virus and who received thromboprophylaxis within February 2020-2021 were included. TE event is a combination of venous [(deep vein thrombosis (DVT), pulmonary embolism (PE)] and arterial (myocardial infarction (MI), stroke) thromboembolism.

Results: Mean (SD) age 56.6 (13.7), 63.5% were male, 61.6% Malays, median (IQR) 7 (3-14) days of ICU stay, 64.2%, 53.2% and 20.9% had underlying hypertension, diabetes and obesity respectively. In total, 240 (44.9%) developed TE event. Significantly higher proportions of COVID-19 patients who developed complications of DVT (2.5% vs. 0.2%; = 0.013), PE (47.5% vs 34.0%; = 0.006), stroke (12.3% vs. 1.5; <0.001) and MI (16.4% vs. 4.6%; <0.001) died. Predictors of TE events were age [HR 1.01 (95% CI 1.00-1.02)], obesity [HR 1.98 (95% CI 1.51-2.6)], D-dimer [HR 1.01 (95% CI 1.00-1.01)], and duration of ICU stay [HR 0.98 (95% CI 0.97-0.99)].

Conclusion: In severely ill COVID-19 patients, TE complications were common, and patients with DVT, PE, stroke, or MI faced increased mortality, even with thromboprophylaxis. Age, obesity, elevated D-Dimer levels, and longer ICU stays were significant predictors of TE events. Considering these findings, a more aggressive approach, combining thromboprophylaxis with enhanced anti-inflammatory treatments, may be necessary for high-risk COVID-19 ICU patients to reduce TE events and mortality.

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