COVID-19 complicated by high Venous Thromboembolism (VTE) and bleed risk in critically ill patients.

Findings from a retrospective China study, shows that COVID-19 (C-19) severe respiratory infection brings with it a high risk of blood clot formation (VTE) and a high bleed risk due to low oxygen levels. A reported 100% VTE incident rate in immobile critically-ill ICU patients, with 60% at high risk of bleeding¹. The study calls for more effective VTE prevention strategies based on an individual assessment of bleeding in these at risk patients.

The data shows that, compared to non-critically ill patients, critically ill C-19 patients were significantly more immobile (p=<0.001) and had significant underlying bleed risks (p=<0.01). Combined, these DVT risk factors contributed to a significantly greater DVT incidence rate in the critically ill C-19 patients studied (p=<0.01).

The paper discusses that anti-coagulation therapy was given based on patient thrombosis and bleed risk assessment and revealed that critically ill C-19 patients had significantly elevated D-dimer and Fibrin Degradation Products (FDP), associated with pulmonary micro-thrombosis. Both are a predictor of patient mortality². In the absence of contraindications, patients with low bleed risk were prescribed low molecular weight heparin (LMWH). Whereas, patients with a high bleed risk were prescribed mechanical compression – IPC devices. These devices enclose the leg in a cuff which fills with air. The cuff inflates and deflates in a repeating cycle moving blood through the veins towards the heart. The increased blood circulation helps prevent the blood from clotting.

Whilst IPC devices do not cause the same bleed complications as drug therapy, the paper does not discuss that IPC is not suitable for all patients, due to fragile skin, a recent wound, ulcer or graft, or allergy to cuff materials.

It is for these critically ill, high bleed risk patients that we have increased production of geko™ devices to help prevent VTE in the accelerating surge in patients with severe breathing difficulties, for whom drug anti-coagulation and IPC devices are contraindicated, impractical or inaccessible.