Venous Thromboembolism in Covid-19 ICU Patients: A Narrative Review

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Noun Eltayeb Ahmed Abdulgader
Abdelrahman Hamza Abdelmoneim Hamza
Hiba Awadelkareem Osman Fadl
Rawan Khidir Abdel Galil
Sahar G. Elbager


Aim: The purpose of this narrative review is to provide a summarized coverage of evidence-based researches reporting VTE in COVID-19 patients in the ICU. It aims to serve as a contribution to healthcare professionals in designing a comprehensive strategy in managing COVID-19 patients.

Background: SARS-CoV-2 (COVID-19) was declared a global pandemic by the WHO in March 2020, as cases continued to surge since January after its sudden outbreak in China. It commonly presents with respiratory symptoms along with a fever, however, comorbidities requiring ICU admission are documented. Several anecdotal reports of VTE amongst ICU patients have surfaced since the outbreak. There is a noticeably increased risk of what appears to be a COVID-19 induced hypercoagulable state despite prophylactic and therapeutic anticoagulation treatment, consequently emphasizing the importance of systemic screening of VTE amongst ICU patients. This calls for a high level of clinical suspicion and a low diagnostic threshold. Understanding the exact impact of VTE on COVID-19 ICU patients improves our ability to reach a timely diagnosis and initiating optimal management to potentially improve survival.

Methods: Google Scholar and Pub Med were used as sources for searching and obtaining the data, as they were critically appraised for the best evidence. The information collected was overviewed and summarized in this narrative review.

Results: After searching in the previously mentioned database, 21 articles were found, assessed, and then filtered to 11 articles in correlation with the review context. 8 full-text articles, 2 case reports, and 1 clinical investigation research were obtained overall. Even with the evidenced data, efficacy of prophylactic anticoagulants remains uncertain but is nonetheless, a practical preventive approach.

Conclusion: COVID-19 infection induces a hypercoagulable state that results in VTE amongst ICU patients. Early prophylactic and therapeutic therapy is deemed essential in the early phases. Further studies are required to develop a better understanding and hence more appropriate management.

COVID-19, thromboembolism, ICU, patients, anticoagulants

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Abdulgader, N. E. A., Hamza, A. H. A., Fadl, H. A. O., Galil, R. K. A., & Elbager, S. G. (2020). Venous Thromboembolism in Covid-19 ICU Patients: A Narrative Review. Asian Hematology Research Journal, 3(3), 35-43. Retrieved from
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World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19. 2020;3(11).


World Health Organization. Coronavirus disease (COVID-19) Situation Report. 2020;135.


Chen Y, Liu Q, Guo D. Emergingcorona-viruses: Genome structure, replication, andpathogenesis. J Med Virol. 2020;92: 418–423.

Available: ET AL.|423

Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020;191:9-14.

Artifoni M, Danic G, Gautier G, Giquel P, Boutoille D, Raffi F. et al. Systematic assessment of venous thromboembolism in COVID‑19 patients receiving thromboprophylaxis: Incidence and role of Ddimer as predictive factors. Journal of Thrombosis and Thrombolysis; 2020.


Demelo-Rodríguez P, Cervilla-Muñoz E, Ordieres-Ortega L, Parra-Virto A, Toledano-Macías M, Toledo-Samaniego N. et al. Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels. Thrombosis Research. 2020;192:23-26.

Pavoni V, Gianesello L, Pazzi M, Stera C, Meconi T, Frigieri F. Evaluation of coagulation function by rotation thromboelastometry in critically ill patients with severe COVID‑19 pneumonia. Journal of Thrombosis and Thrombolysis; 2020.


Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M. et al. High risk of thrombosis in patients with severe SARS‑CoV‑2 infection: A multicenter prospective cohort study. Intensive Care Med; 2020.


Fox S, Akmatbekov A, Harbert J, Li G, Brown J, Heide R. Pulmonary and cardiac pathology in African American patients with COVID-19: An autopsy series from New Orleans. Lancet Respir Med; 2020.

Buja L, Wolf D, Zahao B, Akkanti B, McDonald M, Lelenwa L. et al. The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (COVID-19): Report of 3 autopsies from Houston, Texas, and review of autopsy findings from other United States cities. Cardiovascular Pathology. 2020;48: 107233.

Carranza M, Salazar D, Troya J, Alkazar R, Pena C, Munoz M. Aortic Thrombus in patients with Severe Covid. 2020:19.


Brüggemann R, Gietema H, Jallah B, Cate H, Stehouwer C, paetgens B. Arterial and venous thromboembolic disease in a patient with COVID-19: A case report. Thrombosis Research. 2020;191:153-155.

Llitjos J, Leclerc M, Chochois C, Monsallier J, Ramakers M, Auvray M. et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. J Thromb Haemost. 2020;00:1–4.


Sciagrà R, Rubino F, Malandrino D, Bernardeschi N, Pignone A, Berni A. Are disease-related pulmonary perfusion abnormalities detectable in COVID-19 patients? Suspicious findings in a lung perfusion SPECT performed for ruling out classical pulmonary embolism; 2020.


Klok FA, Kruip M, van der Meer NJM, Arbous MS, Gommers D, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145-7.

Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. Journal of Thrombosis and Haemostasis: JTH. 2020;18(6):1421-4.

Maatman TK, Jalali F, Feizpour C, Douglas A, 2nd, McGuire SP, Kinnaman G, et al. Routine Venous Thromboembolism Prophylaxis May Be Inadequate in the Hypercoagulable State of Severe Coronavirus Disease 2019. Critical care medicine; 2020.

Rodríguez P, Muñoz E, Ortega L, Virto A, Macías M. et al. Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels. Thrombosis Research. 2020;192:23-26.

Middeldorp S, Coppens M, Haaps T, Foppen M, Vlaar A, Müller M. Incidence of venous thromboembolism in hospitalized patients with COVID-19.

DOI:10.1111/JTH.14888 .2020

Temgoua MN, Tochie JN, Noubiap JJ, Agbor VN, Danwang C, Endomba FTA, et al. Global incidence and case fatality rate of pulmonary embolism following major surgery: A protocol for a systematic review and meta-analysis of cohort studies. Systematic Reviews. 2017;6(1):240.

Perkins GD, McAuley DF, Davies S, Gao FJCc. Discrepancies between clinical and postmortem diagnoses in critically ill patients: An observational study. 2003; 7(6):129.

McLeod AG, Geerts WJCcc. Venous thromboembolism prophylaxis in critically ill patients. 2011;27(4):765.

Minet C, Potton L, Bonadona A, Hamidfar-Roy R, Somohano CA, Lugosi M, et al. Venous thromboembolism in the ICU: Main characteristics, diagnosis and thromboprophylaxis. Critical Care. 2015; 19(1):287.

Deshpande C. Thromboembolic Findings in COVID-19 Autopsies: Pulmonary Thrombosis or Embolism? Annals of Internal Medicine; 2020.

Wong RSM, Wu A, To KF, Lee N, Lam CWK, Wong CK, et al. Haematological manifestations in patients with severe acute respiratory syndrome: Retrospective analysis. BMJ. 2003; 326(7403):1358.

Stone J, Hangge P, Albadawi H, Wallace A, Shamoun F, Knuttien MG, et al. Deep vein thrombosis: Pathogenesis, diagnosis, and medical management. Cardiovasc Diagn Ther. 2017;7(3):276-84.

Fontaine GV, Vigil E, Wohlt PD, Lloyd JF, Evans RS, Collingridge DS, et al. Venous Thromboembolism in Critically Ill Medical Patients Receiving Chemoprophylaxis: A Focus on Obesity and Other Risk Factors. Clinical and Applied Thrombosis/ Hemostasis. 2015;22(3):265-73.

Tovey C, Wyatt S. Diagnosis, investigation, and management of deep vein thrombosis. BMJ. 2003;326(7400): 1180-4.

Lippi G, Favaloro EJ. D-dimer is Associated with severity of coronavirus disease 2019: A Pooled Analysis. Thromb Haemost. 2020;120(05):876-8.

Yin S, Huang M, Li D, Tang N. Difference of coagulation features between severe pneumonia induced by SARS-CoV2 and non-SARS-CoV2. Journal of Thrombosis and Thrombolysis; 2020.

Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003; 348(20):1986-94.