| Abstract [eng] |
During the COVID-19 pandemic it came to the attention that despite usual prophylaxis, there was a significant increase in the incidence of thromboembolic complications in critically ill patients. Escalation of the anticoagulant dosage has been considered, but due to the rapidly evolving situation, the impact of different strategies on the incidence of thrombotic events, bleeding, and mortality was unknown. Now, over 5 years since the first COVID-19 case, results of randomised controlled trials are available, allowing us to choose the appropriate preventative strategy for these patients. Aim: to analyse recent literature on the incidence and characteristics of thromboembolic complications in critically ill COVID-19 patients and the impact of different thromboprophylaxis strategies on the incidence of thromboembolism, bleeding, and mortality, providing conclusions and recommendations. Methods: the PubMed database was searched using the keywords "COVID-19", "intensive care unit", "critical", "thromboembolic complications", "thrombosis", "anticoagulants". Open-access articles in English published up to April 2024 were selected and analysed. Results and conclusions: critically ill COVID-19 patients face an increased risk of thromboembolic complications; symptomatic thrombosis occurs in 11% to 49% of cases and is associated with increased mortality. Most complications occur in the venous circulation, while autopsy findings show pulmonary microthrombosis. This group of patients should be administered with standard prophylactic doses of low molecular weight heparins or unfractionated heparin. Higher doses didn’t reduce mortality or thrombosis incidence and carried a higher risk of bleeding. The diagnostic workup and treatment of venous thromboembolism in COVID-19 patients do not differ from uninfected patients. |
