scholarly journals Markers Of Coagulation And Hemostatic Activation Identify COVID-19 Patients At High Risk For Thrombotic Events, ICU Admission and Intubation

2020 ◽  
Author(s):  
Darwish Alabyad ◽  
Srikant Rangaraju ◽  
Michael Liu ◽  
Rajeel Imran ◽  
Christine L. Kempton ◽  
...  
Keyword(s):  
Thrombotic Event ◽  
Anticoagulation Therapy ◽  
Vascular Events ◽  
Icu Admission ◽  
Vein Thrombosis ◽  
Coagulation Marker ◽  
Increased Risk ◽  
Patients At Risk ◽  
Deep Vein ◽  
D Dimer

ABSTRACTBackgroundCoronavirus disease 2019 (COVID-19) has been associated with a coagulopathy giving rise to venous and arterial thrombotic events. The objective of our study was to determine whether markers of coagulation and hemostatic activation (MOCHA) on admission could identify COVID-19 patients at risk for thrombotic events and other complications.MethodsCOVID-19 patients admitted to a tertiary academic healthcare system from April 3, 2020 to July 31, 2020 underwent standardized admission testing of MOCHA profile parameters (plasma d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, and fibrin monomer) with abnormal MOCHA defined as ≥ 2 markers above the reference. Prespecified thrombotic endpoints included deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, and access line thrombosis; other complications included ICU admission, intubation and mortality. We excluded patients on anticoagulation therapy prior to admission and those who were pregnant.ResultsOf 276 patients (mean age 59 ± 6.4 years, 47% female, 62% African American race) who met study criteria, 45 (16%) had a thrombotic event. Each coagulation marker on admission was independently associated with a vascular endpoint (p<0.05). Admission MOCHA with ≥ 2 abnormalities (n=203, 74%) was associated with in-hospital vascular endpoints (OR 3.3, 95% CI 1.2-8.8), as were admission D-dimer ≥ 2000 ng/mL (OR 3.1, 95% CI 1.5-6.6), and admission D-dimer ≥ 3000 ng/mL (OR 3.6, 95% CI 1.6-7.9). However, only admission MOCHA with ≥ 2 abnormalities was associated with ICU admission (OR 3.0, 95% CI 1.7-5.2) and intubation (OR 3.2, 95% CI 1.6-6.4), while admission D-dimer ≥2000 ng/mL and admission D-dimer ≥ 3000 ng/mL were not associated. MOCHA and D-dimer cutoffs were not associated with mortality. Admission MOCHA with <2 abnormalities (26% of the cohort) had a sensitivity of 88% and negative predictive value of 93% for a vascular endpoint.ConclusionsAdmission MOCHA with ≥ 2 abnormalities identified COVID-19 patients at increased risk of ICU admission and intubation during hospitalization more effectively than isolated admission D-dimer measurement. Admission MOCHA with <2 abnormalities identified a subgroup of patients at low risk for vascular events. Our results suggest that an admission MOCHA profile can be useful to risk-stratify COVID-19 patients.

Abstract P112: Markers of Coagulation and Hemostatic Activation Identify Covid-19 Patients at High Risk for Thrombotic Events

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Darwish Alabyad ◽  
Srikant RANGARAJU ◽  
Michael Liu ◽  
Rajeel Imran ◽  
Christine L Kempton ◽  
...  
Keyword(s):  
At Risk ◽  
Thrombotic Event ◽  
Anticoagulation Therapy ◽  
Composite Endpoint ◽  
Icu Admission ◽  
Vein Thrombosis ◽  
Coagulation Marker ◽  
Patients At Risk ◽  
Thrombotic Complications ◽  
Deep Vein

Introduction: COVID-19 has been associated with venous and arterial thrombotic complications. The objective of our study was to determine whether markers of coagulation and hemostatic activation (MOCHA) on admission could identify COVID-19 patients at risk for thrombotic events. Methods: COVID-19 patients admitted to a tertiary academic healthcare system from April 3, 2020 to July 31, 2020 underwent admission testing of MOCHA profile parameters (plasma d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, and fibrin monomer). For this analysis we excluded patients on outpatient anticoagulation therapy preceding admission. Prespecified endpoints monitored during hospitalization included deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke and access line thrombosis. Results: During the study period, 276 patients were included in the analysis cohort (mean age 59 ± 6.3 years, 47% female, 83% non-white race). Arterial and venous thrombotic events occurred in 43 (16%) patients (see Table). Each coagulation marker was independently associated with the composite endpoint (p<0.05). Admission MOCHA with ≥ 2 abnormalities was associated with the composite endpoint (OR 3.1, 95% CI 1.2-8.3), ICU admission (OR 3.2, 95% CI 1.8-5.5) and intubation (OR 2.8, 95% CI 1.5-5.5). Admission MOCHA with < 2 abnormalities (26% of the cohort) had sensitivity of 88% and a negative predictive value of 93% for an in-hospital endpoint. Conclusion: Admission MOCHA with ≥ 2 abnormalities identified COVID-19 patients at risk for a thrombotic event, ICU admission and intubation while < 2 abnormalities identified a subgroup of patients who were at low risk for thrombotic events. Our results suggest that an admission MOCHA profile can be useful to risk stratify COVID-19 patients. Further studies are needed to determine whether an admission MOCHA profile can guide anticoagulation therapy and improve overall clinical outcomes.

scholarly journals Validation of an admission coagulation panel for risk stratification of COVID-19 patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248230
Author(s):  
Darwish Alabyad ◽  
Srikant Rangaraju ◽  
Michael Liu ◽  
Rajeel Imran ◽  
Christine L. Kempton ◽  
...  
Keyword(s):  
Thrombotic Event ◽  
Observational Cohort Study ◽  
Limited Data ◽  
Icu Admission ◽  
Vein Thrombosis ◽  
Patients At Risk ◽  
Observational Cohort ◽  
Thrombotic Complications ◽  
Deep Vein ◽  
D Dimer

Background There is limited data on the markers of coagulation and hemostatic activation (MOCHA) profile in Coronavirus disease 2019 (COVID-19) and its ability to identify COVID-19 patients at risk for thrombotic events and other complications. Methods Hospitalized patients with confirmed SARS-COV-2 from four Atlanta hospitals were included in this observational cohort study and underwent admission testing of MOCHA parameters (plasma d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex, fibrin monomer). Clinical outcomes included deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, access line thrombosis, ICU admission, intubation and mortality. Main results Of 276 patients (mean age 59 ± 6.4 years, 47% female, 62% African American), 45 (16%) had a thrombotic endpoint. Each MOCHA parameter was independently associated with a thrombotic event (p<0.05) and ≥ 2 abnormalities was associated with thrombotic endpoints (OR 3.3, 95% CI 1.2–8.8) as were admission D-dimer ≥ 2000 ng/mL (OR 3.1, 95% CI 1.5–6.6) and ≥ 3000 ng/mL (OR 3.6, 95% CI 1.6–7.9). However, only ≥ 2 MOCHA abnormalities were associated with ICU admission (OR 3.0, 95% CI 1.7–5.2) and intubation (OR 3.2, 95% CI 1.6–6.4). MOCHA and D-dimer cutoffs were not associated with mortality. MOCHA with <2 abnormalities (26% of the cohort) had 89% sensitivity and 93% negative predictive value for a thrombotic endpoint. Conclusions An admission MOCHA profile is useful to risk-stratify COVID-19 patients for thrombotic complications and more effective than isolated d-dimer for predicting risk of ICU admission and intubation.

scholarly journals THE ASSOCIATION BETWEEN D-DIMER AND DEEP VEIN THROMBOSIS LOCATION AND ITS ABILITY TO PREDICT PULMONARY EMBOLISM, a retrospective pilot study

2019 ◽  
Author(s):  
Sarah Ali Althomali ◽  
Adel S. Alghamdi ◽  
Tareef H. Gnoot ◽  
Mohammad A. Alhassan ◽  
Abdullatif H. Ajaimi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Risk Group ◽  
Great Role ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Risk Patients ◽  
Deep Vein ◽  
Limb Deep Vein Thrombosis ◽  
D Dimer

Abstract Background In lower limb deep vein thrombosis; it is important to identify proximal from distal deep vein thrombosis as it carries the highest risk of pulmonary embolism. It is known that D-dimer has a great role in deep vein thrombosis diagnosis. Yet, the use of D-dimer to predict the location of deep vein thrombosis and the risk of pulmonary embolism in deep vein thrombosis patients has not been investigated before. Objective To address the correlation between D-dimer and the location of deep vein thrombosis and to study the efficacy of D-dimer to predict risk of PE in patients with proximal or extensive deep vein thrombosis. Method We included 110 consecutive patients who were hospitalized with the diagnosis of deep vein thrombosis, with or without a concomitant diagnosis of PE, and with D-dimer measured at initial presentation. We categorized the location of deep vein thrombosis as: distal, proximal, and extensive. In the analysis, patients were grouped into high-risk (patients with Proximal or Extensive deep vein thrombosis and pulmonary embolism) and low risk group (patients without pulmonary embolism). Results There was no significant association between D-dimer level and the location of deep vein thrombosis (p=0.519). However, D-dimer level was greater among patients with pulmonary embolism (9.6mg/L) than among patients without pulmonary embolism (7.4mg/L), (p=0.027). D-dimer was a significant predictor of pulmonary embolism as patients with proximal or extensive deep vein thrombosis had 8-folds increased risk of pulmonary embolism than patients with D-dimer less than 4.75mg/L (OR=7.9, p=0.013). Conclusion Though D-dimer was not significantly associated with the location of deep vein thrombosis, it was a significant predictor of pulmonary embolism in patients hospitalized with proximal or extensive deep vein thrombosis.

Elevated Hematocrit Concentration and the Risk of Mortality and Vascular Events in Patients Undergoing Major Surgery.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2088-2088 ◽  
Author(s):  
Khaled M Musallam ◽  
John B Porter ◽  
Assaad Soweid ◽  
Jamal J Hoballah ◽  
Pierre M Sfeir ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Postoperative Mortality ◽  
Major Surgery ◽  
Vascular Events ◽  
Improvement Program ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Deep Vein ◽  
The Impact

Abstract Abstract 2088 Background: Preoperative anemia is associated with adverse outcomes after major surgery. This study evaluates the effect of elevated hematocrit concentration on 30-day postoperative mortality and vascular events in patients undergoing major surgery. Methods: We conducted a cohort study using the American College of Surgeons National Surgical Quality Improvement Program database. Thirty-day mortality and vascular events, demographic, and perioperative risk factors were obtained for 197,469 adult patients undergoing major surgery in nonveteran's administration hospitals across the US, Canada, Lebanon, and the UAE during 2008 and 2009. We assessed the adjusted effect of elevated (>0.50) compared to normal preoperative hematocrit concentration (≥0.41–0.50, American Medical Association reference-range) on postoperative outcomes. Separate sex-specific analysis using hematocrit concentration thresholds commonly used in the diagnosis and management of patients with apparent or absolute erythrocytosis was also done. Results: A total of 3,961 patients (2.0%) had elevated hematocrit concentration preoperatively. After adjustment, postoperative mortality at 30 days was higher in patients with elevated hematocrit concentration than in those without (odds ratio [OR]: 2.23, 95% CI: 1.77–2.80). 30-day deep vein thrombosis (OR: 1.95, 95% CI: 1.44–2.64) and pulmonary embolism (OR: 1.79, 95% CI: 1.17–2.73), but not myocardial infarction or cerebrovascular events, were also higher in patients with elevated hematocrit concentration than in those without. Similar evaluation of various clinically relevant hematocrit concentrations revealed the following: an effect on mortality was noted beyond the thresholds of 0.48 in women and 0.52 in men, with the effect estimates becoming considerably high for values >0.54. Values between 0.41–0.45 were not associated with increased odds mortality. Similar observations were noted for deep vein thrombosis, although with higher variation and uncertainty especially in women; while the effects on pulmonary embolism were restricted to men. Conclusion: Elevated hematocrit concentration is associated with an increased risk of 30-day mortality and venous thrombosis following major surgery. Further investigation of the impact of elevated hematocrit concentration and its reduction on surgical outcomes is warranted. Disclosures: No relevant conflicts of interest to declare.

Thrombus Burden of Deep Vein Thrombosis and Its Association with Thromboprophylaxis and D-Dimer Measurement: Insights from the APEX Trial

2017 ◽  
Vol 117 (12) ◽  
pp. 2389-2395 ◽  
Author(s):  
Gerald Chi ◽  
Samuel Goldhaber ◽  
Russell Hull ◽  
Adrian Hernandez ◽  
Mathieu Kerneis ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Medical Patients ◽  
Clinical Trial Registration ◽  
Full Dose ◽  
Treatment Groups ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Extended Duration ◽  
Deep Vein ◽  
D Dimer

Background The aim of this study was to evaluate the effect of betrixaban on the occurrence of deep vein thrombosis (DVT) and also the extent of thrombus and to assess the association of baseline D-dimer with subsequent thrombus burden. Methods In the APEX trial (ClinicalTrials.gov: NCT01583218), 7,513 acutely ill hospitalized medical patients were randomly assigned to extended-duration betrixaban (35–42 days) or enoxaparin (10 ± 4 days). D-dimer concentration was measured at baseline, and mandatory lower-extremity compression ultrasonography (CUS) was performed at 35 to 42 days. The thrombus burden of DVT was assessed by the number of non-compressible vascular segments in six target proximal veins and compared between treatment groups and D-dimer categories (≥2 × upper limit of normal [ULN] versus <2 × ULN). Results Compared with enoxaparin, extended-duration betrixaban reduced the DVT risk at 35 to 42 days (any-dose: relative risk [RR] = 0.76 [95% confidence interval: 0.61–0.94]; p = 0.013; full-dose: RR = 0.70 [0.55–0.90]; p = 0.005). Patients who received betrixaban were more likely to have a lower thrombus burden (p = 0.012 for any-dose and p = 0.001 for full-dose). Elevated D-dimer at baseline was independently associated with a 2.12-fold increased risk of developing DVT (p < 0.001). A greater thrombus burden was also observed in those with D-dimer ≥ 2 × ULN compared with <2 × ULN (p < 0.0001). Conclusion Extended-duration betrixaban reduced the number of venous segments with thrombosis at 35 to 42 days compared with enoxaparin. A positive D-dimer was associated with a greater extent of thrombus burden among acutely ill medical patients who developed DVT despite receiving thromboprophylaxis. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. ClinicalTrials.gov identifier: NCT01583218.

scholarly journals ETIOPATOGENIA E DIAGNÓSTICO DA TROMBOSE VENOSA PROFUNDA NA GESTAÇÃO: REVISÃO DE LITERATURA

2018 ◽  
Vol 5 (4) ◽  
pp. 51-55
Author(s):  
Vinícius Barros Prehl ◽  
Gabriel Leal Costa Moura ◽  
Fellipe Camargo Ferreira Dias ◽  
Roniel Thalles Almeida da Silva Rosa ◽  
Antônio Fagundes da Costa Júnior
Keyword(s):  
Venous Thrombosis ◽  
Signs And Symptoms ◽  
Prothrombotic State ◽  
Vein Thrombosis ◽  
Tromboembolismo Venoso ◽  
Increased Risk ◽  
Maternal Morbidity And Mortality ◽  
Epidemiological Pattern ◽  
Deep Vein ◽  
D Dimer

Introdução: A gestação e o período pós-parto estão associados a diversas alterações fisiológicas que resultam na elevação do risco de eventos tromboembólicos. O tromboembolismo venoso (TEV) representa uma importante causa de morbimortalidade materna e se apresenta por meio de duas entidades clínicas diferentes: embolia pulmonar (EP) e trombose venosa profunda (TVP). A manifestação de sinais e sintomas comuns durante a gravidez associada à limitação do uso de radiação e elevação progressiva normal do D-dímero tornam o diagnóstico da TVP na gestação um desafio. Desenvolvimento: Trata-se de um artigo de revisão a partir de trabalhos selecionados sistematicamente nas bases de dados MEDLINE e LILACS com base nos indexadores: trombose venosa, gravidez e diagnóstico. Considerações finais: A gestação representa um estado pró-trombótico transitório, onde todos os componentes da tríade de Virchow são afetados. Diversos fatores associados ao período gestacional resultam em um padrão epidemiológico e de manifestação clínica distinto da população não gestante. A TVP representa a maioria dos casos de TEV sintomáticos no período pré-parto e acomete predominantemente o sistema venoso proximal. O estado pró-trombótico resulta na elevação dos níveis de D-dímero na gravidez, diminuindo a especificidade do exame. A ultrassonografia compressiva representa o exame de escolha diante da suspeita de TVP na gestação. A investigação diagnóstica possui limitações importantes e necessita de estudos direcionados para o desenvolvimento e aperfeiçoamento de estratégias para o diagnóstico de TVP em gestante.   Palavras-chave: Trombose Venosa; Gravidez; Diagnóstico. ABSTRACT Introduction: Gestation and the postpartum period are associated with several physiological changes that result in an increased risk of thromboembolic events. Venous thromboembolism (VTE) is an important cause of maternal morbidity and mortality and is presented through two different clinical entities: pulmonary embolism (PE) and deep vein thrombosis (DVT). The manifestation of common signs and symptoms during pregnancy associated with limitation in the use of radiatiotn and normal progressive elevation of D-dimer make the diagnosis of DVT during pregnancy challenging. Development: This is a review article based on systematically selected papers in the MEDLINE and LILACS databases based on the indexes: venous thrombosis, pregnancy and diagnosis. Final considerations: Gestation represents a transient prothrombotic state, where all components of the Virchow triad are affected. Several factors associated with the gestational period result in an epidemiological pattern and distinct clinical manifestation of the non-pregnant population. DVT represents the majority of cases of symptomatic VTE in the prepartum period and predominantly affects the proximal venous system. The prothrombotic state results in elevation of D-dimer levels in pregnancy, decreasing the specificity of the test. Compression ultrasonography represents the examination of choice in view of the suspicion of DVT during pregnancy. The diagnostic investigation has important limitations and needs studies directed to the development and improvement of strategies for the diagnosis of DVT in pregnant women. Keywords: Venous Thrombosis; Pregnancy; Diagnosis.

scholarly journals Risk Factors and Anticoagulation Therapy in Patients With Isolated Distal Deep Vein Thrombosis in the Early Post-operative Period After Thoracic Surgery

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuping Li ◽  
Junrong Ding ◽  
Lei Shen ◽  
Jian Yang ◽  
Haifeng Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Deep Vein Thrombosis ◽  
Thoracic Surgery ◽  
Anticoagulation Therapy ◽  
Vein Thrombosis ◽  
Half Dose ◽  
Deep Vein ◽  
D Dimer

Background: Isolated distal deep vein thrombosis (IDDVT) accounts for ~50% of all patients diagnosed with deep venous thrombosis (DVT), but the diagnosis and optimal management of IDDVT remains unclear and controversial. The aim of this study was to explore potential risk factors and predictors of IDDVT, and to evaluate different strategies of anticoagulation therapy.Methods: A total of 310 consecutive patients after thoracic surgery, who underwent whole-leg ultrasonography as well as routine measurements of D-dimer levels before and after surgery were evaluated. The general clinical data, anticoagulant therapy, pre- and postoperative D-dimer levels were collected. Differences between IDDVT, DVT and non-DVT groups were calculated. Logistic regression analysis was used to analyze risk factors of postoperative IDDVT.Results: Age and postoperative D-dimer levels were significantly higher in IDDVT group than in non DVT group (p = 0.0053 and p &lt; 0.001, respectively). Logistic regression analysis showed that postoperative D-dimer level was a significant independent predictor of IDDVT even when adjusted for age and operation method (p = 0.0003). There were no significant side effects associated with both full-dose and half-dose anticoagulation regimens. Half-dose therapy was associated with a significant decrease in the requirement for anticoagulation medications after discharge (p = 0.0002).Conclusion: Age and D-dimer levels after surgery are strong predictors of IDDVT following thoracic surgery. Half-dose therapeutic anticoagulation has the same efficiency in preventing IDDVT progression, is not associated with any additional risks of adverse effects compared to a full-dose regimen, and may be adopted for treating IDDVT patients after thoracic surgery.

scholarly journals Glioblastoma dengan Deep Vein Thrombosis pada pasien COVID-19: Sebuah Laporan Kasus

2020 ◽  
Vol 7 (1A) ◽  
pp. 181-188
Author(s):  
Dodik Tugasworo ◽  
Aditya Kurnianto ◽  
Retnaningsih Retnaningsih ◽  
Yovita Andhitara ◽  
Rahmi Ardhini ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Severe Infection ◽  
Lung Damage ◽  
Coagulation Cascade ◽  
Tumor Biopsy ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Deep Vein ◽  
D Dimer

Latar belakang: Glioblastoma (GBM) berhubungan dengan peningkatan hiperkoagulabilitas dan peningkatan risiko dari venous thromboembolism (VTE) (termasuk Deep Vein Thrombosis (DVT)). VTE merupakan komplikasi kardiovaskular atau respirasi yang sering ditemukan pada pasien-pasien yang dirawat inap karena COVID-19. Hubungan mengenai VTE pada kasus GBM dan COVID-19 belum pernah dibahas sebelumnya. Laporan kasus ini akan membahas tentang seorang wanita usia 55 tahun dengan GBM dan DVT dengan hasil PCR SARS-CoV-2 positif yang dirawat di RSUP Dr. Kariadi. Laporan kasus: Wanita 55 tahun datang ke rumah sakit dengan nyeri kepala dan nyeri serta bengkak pada tungkai kanan. Pada pemeriksaan laboratorium didapatkan INR 0.92, D-Dimer kuantitatif 46540 ug/L, dan titer fibrinogen kuantitatif 234 mg/dL. Dari USG vena doppler tungkai kanan didapatkan gambaran DVT sepanjang vena tungkai kanan, pada pemeriksaan MRI kepala dan biopsi tumor sesuai dengan gambaran GBM, hasil pemeriksaan foto rontgen thoraks terjadi perburukan gambaran paru, serta pemeriksaan PCR SARS-CoV-2 positif. Pembahasan: Pada pasien ini, kondisi GBM dapat menyebabkan adanya kondisi hiperkoagulabilitas akibat neoangiogenesis, mutase onkogenik, dan aktivitas kronik kaskade koagulasi. Selain itu, infeksi dan inflamasi yang berat berkontribusi dalam berkembangnya DVT, seperti yang ditemukan pada pasien dengan COVID-19 yang parah. Pada pasien rawat inap dengan COVID-19, prevalensi DVT tinggi dan biasanya memiliki outcome yang buruk. Istilah COVID-19 associated coagulopathy (CAC) digunakan untuk menggambarkan perubahan koagulasi pada pasien yang terinfeksi COVID. Simpulan: Peningkatan risiko DVT pada pasien dengan glioblastoma dan infeksi COVID-19 disebabkan hiperkoagulabilitas dan koagulopati akibat sel tumor dan virus SARS-CoV-2. Kata Kunci: glioblastoma, DVT, COVID-19   Introduction: GBM is associated with increased of hypercoagulability and the risk of venous thromboembolism (VTE) (include Deep Vein Thrombosis (DVT)). VTE is a cardiovascular or respiratory complication that is often found in patients with COVID-19. The relationship of VTE in GBM and COVID-19 has not been discussed before. This case report will discuss a 55-year-old woman with GBM and DVT with a positive SARS-CoV-2 treated at Dr. Kariadi Hospital. Case presentation: A 55-year-old woman came to the hospital with cephalgia, pain and redness in the right leg. On laboratory examination, it was obtained INR 0.92, quantitative D-Dimer 46540 ug/L, and quantitative fibrinogen titer 234 mg/dL. Venous doppler USG of right leg showed the imaging of DVT along the venous system in right leg. Head MRI and tumor biopsy showed the imaging of GBM, on the chest X-ray examination showed the deterioration of the lung damage, and positive SARS-CoV-2 with PCR examination. Discusssion: GBM can cause hypercoagulability due to neoangiogenesis, oncogenic mutation, and chronic coagulation cascade activity. In addition, severe infection and inflammation contribute to the development of DVT, as found in patients with severe COVID-19. In hospitalized patients with COVID-19, the prevalence of DVT is high and usually has a poor outcome. The term COVID-19 associated coagulopathy (CAC) is used to describe changes in coagulation in patients infected with COVID-19. Conclusion: Increased risk of DVT in GBM and COVID-19 is because of hypercoagulability and coagulopathy due to tumor cells and SARS-CoV-2 virus. Keywords: glioblastoma, DVT, COVID-19

scholarly journals Venous Thromboembolism among Hospitalized Patients with COVID-19 Undergoing Thromboprophylaxis: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 9 (8) ◽  
pp. 2489 ◽  
Author(s):  
Gerald Chi ◽  
Jane J. Lee ◽  
Adeel Jamil ◽  
Vamsikrishna Gunnam ◽  
Homa Najafi ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Risk Stratification ◽  
Meta Analysis ◽  
Preliminary Evidence ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
The Difference ◽  
Prophylactic Anticoagulation ◽  
Deep Vein ◽  
D Dimer

Background: Preliminary evidence indicates that prophylactic-dose thromboprophylaxis may be inadequate to control the increased risk of venous thromboembolism (VTE) in patients hospitalized for coronavirus disease 2019 (COVID-19) infection. Additionally, it remains unclear whether the D-dimer measurement is useful for VTE risk stratification among COVID-19 patients. This study aimed to offer benchmark data on the incidence of VTE and to examine the difference in D-dimer levels among anticoagulated COVID-19 patients with and without VTE incident. Methods: A comprehensive literature review of PubMed from inception to May 2020 was performed for original studies that reported the frequency of VTE and death among COVID-19 patients who received thromboprophylaxis on hospitalization. The endpoints included VTE (a composite of pulmonary embolism (PE) or deep vein thrombosis (DVT)), PE, DVT, and mortality. Results: A total of 11 cohort studies were included. Among hospitalized COVID-19 patients, 23.9% (95% confidence interval (CI), 16.2% to 33.7%; I2 = 93%) developed VTE despite anticoagulation. PE and DVT were detected in 11.6% (95% CI, 7.5% to 17.5%; I2 = 92%) and 11.9% (95% CI, 6.3% to 21.3%; I2 = 93%) of patients, respectively. Patients in the intensive care unit (ICU) had a higher risk for VTE (30.4% )95% CI, 19.6% to 43.9%)) than those in the ward (13.0% (95% CI, 5.9% to 26.3%)). The mortality was estimated at 21.3% (95% CI, 17.0% to 26.4%; I2 = 53%). COVID-19 patients who developed VTE had higher D-dimer levels than those who did not develop VTE (mean difference, 2.05 µg/mL; 95% CI, 0.30 to 3.80 µg/mL; P = 0.02). Conclusions: The heightened and heterogeneous risk of VTE in COVID-19 despite prophylactic anticoagulation calls into research on the pathogenesis of thromboembolic complications and strategy of thromboprophylaxis and risk stratification. Prominent elevation of D-dimer may be associated with VTE development and can be used to identify high-risk subsets.

Increased risk of deep-vein thrombosis in patients with multiple myeloma receiving thalidomide and chemotherapy

Blood ◽  
2001 ◽  
Vol 98 (5) ◽  
pp. 1614-1615 ◽  
Author(s):  
Maurizio Zangari ◽  
Elias Anaissie ◽  
Bart Barlogie ◽  
Ashraf Badros ◽  
Raman Desikan ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Deep Vein Thrombosis ◽  
Induction Chemotherapy ◽  
Anticoagulation Therapy ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Induction Cycle ◽  
Multiagent Chemotherapy ◽  
Deep Vein ◽  
To Receive

The occurrence of deep-vein thrombosis (DVT) in patients with newly diagnosed multiple myeloma, who were randomly assigned to receive identical induction chemotherapy with or without thalidomide, are reported in this study. The 2 study arms were comparable with respect to key myeloma prognostic factors and known risk factors for DVT. One hundred patients received induction chemotherapy including 4 cycles of continuous infusion of combinations of dexamethasone, vincristine, doxorubicin, cyclophosphamide, etoposide, and cisplatin, and each patient completed at least one induction cycle. DVT developed in 14 of 50 patients (28%) randomly assigned to receive thalidomide but in only 2 of 50 patients (4%) not given the agent (P = .002). All episodes of DVT occurred during the first 3 cycles of induction. Administration of thalidomide was resumed safely in 75% of patients receiving anticoagulation therapy. Thus, thalidomide given in combination with multiagent chemotherapy and dexamethasone is associated with a significantly increased risk of DVT, which appears to be safely treated with anticoagulation and does not necessarily warrant discontinuation of thalidomide.

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