Cumulative incidence of thrombotic complications in severeCovid 19 disease. the Trento sub-intensive care unit cohort

Background and Aims: A pro-thrombotic state has been shownto be part of the spectrum the SARS-CoV2 infection We aimed toinvestigate the incidence of thrombotic events in a cohort of patients admitted to the sub-intensive care unit - SICU in Trento Methods: Venous ultrasonography of the lower limbs was systematically performed in all COVID19 patients admitted to the SICUat S Chiara Hospital, Trento, from March 21st to May 4th In-hospitalcumulative incidences (CI) of thrombosis and major bleeding(ISTH definition) were calculated Results: 46 consecutive patients were included (male 35/46, 76%;mean age 63, IQR 55-74) All but 5 were treated with CPAP Meand-dimer, PLT and PCR levels were 657 ng/ml (IQR 294-658),241x109/L (IQR 168-294), and 108 mg/L (IQR 60-150), respectively All patients received low molecular weight heparin (LMWH) atintermediate dosage (100 UI/kg/24h), irrespective on the d-dimerlevel The CI of venous thromboembolic events was 6 5% (3/46;one pulmonary embolism associated with calf thrombosis, one subclavian vein thrombosis, one isolated calf thrombosis) No patienthad arterial thrombosis All thromboses developed at the ICU (19%of all patients stepped-up to the ICU, 3/16) Overall, the CI of majorbleeding was 4 3% (2/46, one gastrointestinal bleeding, one CNSbleeding after pulmonary embolism) Conclusions: In our experience of SARS-CoV 2 patients treatedwith an intermediate dose of LMWH, we observed thrombotic complications only in those who required invasive ventilation The balance between thrombosis and bleeding should always be takeninto account