Deep Venous Thrombosis in COVID-19 Patients: A Cohort Analysis

Deep venous thrombosis (DVT) is a severe complication of coronavirus disease 2019 (COVID-19). The purpose of this study was to study the prevalence, risk factors, anticoagulant therapy and sex differences of DVT in patients with COVID-19. The enrolled 121 hospitalized non-ventilator patients were confirmed positive for COVID-19. All suspected patients received color Doppler ultrasound (US) to screen for DVT in both lower extremities. Multivariate logistic regression was performed to identify risk factors related to DVT in COVID-19 patients. DVT was found in 48% of the asymptomatic COVID-19 patients with an increased PADUA or Caprini index using US scanning. The multivariate logistic regression determined that age (OR, 1.05; p = .0306), C-reactive protein (CRP) (OR, 1.02; p = .0040), and baseline D-dimer (OR, 1.42; p = .0010) were risk factors among COVID-19 patients. Although the most common DVT location was infrapopliteal (classes I and II), higher mortality in DVT-COVID-19 patients was confirmed. DVT-COVID-19 patients presented significant increases in CRP, neutrophil count, and D-dimer throughout the whole inpatient period compared to non-DVT-COVID-19 patients. Although anticoagulation therapy accelerated the recovery of lymphocytopenia in DVT patients, men DVT-COVID-19 patients with anticoagulant therapy showed significant higher CRP and neutrophil count vs. lymphocyte count (N/L) ratio, but showed lower lymphocyte counts compared to women DVT-COVID-19 patients. DVT is common in COVID-19 patients with high-risk factors, especially for older age and higher CRP and baseline D-dimer populations. It is important to consider sex differences in anticoagulant therapy among DVT-COVID-19 patients.

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Deep Venous Thrombosis in COVID-19 Patients: A Cohort Analysis

10.21203/rs.3.rs-39414/v1 ◽

2020 ◽

Author(s):

Yi Guo ◽

Yun You ◽

Ke Hu ◽

Fei Cai ◽

Yiqing Li ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Sex Difference ◽

Anticoagulant Therapy ◽

Neutrophil Count ◽

Anticoagulation Therapy ◽

Multivariate Logistic Regression ◽

D Dimer

Abstract BackgroundDeep venous thrombosis (DVT) is a severe complication of the coronavirus disease 2019 (COVID-19). It may interfere with COVID-19 treatment and delay the recovery, but there is less data about the anticoagulant therapy and sex difference of VTE in patients with COVID-19. The purpose of this study is to study the prevalence, risk factors, anticoagulant therapy and sex difference of deep venous thrombosis (DVT) in patients with COVID-19.MethodsThe enrolled 121 patients were confirmed positive for COVID-19. All suspected patients with a high Caprini index (≥4) or PADUA index (≥4) received color Doppler Ultrasound (US) to screen DVT in both lower extremities. Clinical characteristics of DVT-COVID-19 patients were analyzed. Multivariate logistic regression was performed to identify risk factors related to DVT in COVID-19 patients. The distribution of DVT locations, anticoagulation therapy with sex difference, and the outcomes were also analyzed.ResultsDVT was found in 48% asymptomatic COVID-19 patients with increased PAUDA index or Caprini index by US scanning. Multivariate logistic regression determined that age, CRP and baseline D-dimer were risk factors among COVDI-19 patients. Although the most common DVT location was infrapopliteal (Class I and Class II), higher mortality in DVT-COVID-19 patients was confirmed. DVT-COVID-19 patients presented significant increases in the CRP, neutrophil count and D-dimer throughout the whole inpatient period compared to non-DVT-COVID-19 patients. Although anticoagulation therapy accelerated the recovery of lymphocytopenia condition in DVT patients, men DVT-COVID-19 patients showed higher CRP and neutrophil count vs. lymphocyte count (N/L) ratio but lower lymphocyte count compared to women DVT-COVID-19 patients. ConclusionsDVT is common in COVID-19 patients with high risk factors, especially for older age, higher CRP and baseline D-dimer populations. It is important to consider sex differences in the anticoagulant therapy among DVT-COVID-19 patients.

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Anti-PLA2R Antibodies Measured by ELISA Predict the Risk of Vein Thrombosis in Patients With Primary Membranous Nephropathy

10.21203/rs.3.rs-257157/v1 ◽

2021 ◽

Author(s):

Huizi Zhu ◽

Liang Xu ◽

Xiang Liu ◽

Bing Liu ◽

Xiaowei Yang ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Venous Thrombosis ◽

Membranous Nephropathy ◽

Enzyme Linked Immunosorbent Assay ◽

Multivariate Logistic Regression ◽

Vein Thrombosis ◽

Independent Risk Factors ◽

Antibody Levels ◽

D Dimer

Abstract BackgroundPrimary membranous nephropathy (PMN) is associated with the highest risk for developing venous thrombosis compared with other nephrotic diseases. The aim of the study was to assess the predictive value of the pathognomonic anti-PLA2R antibody with regard to incidence of venous thrombosis in PMN.Methods269 PMN patients with venous thrombosis examination were collected and analyzed. Anti-PLA2R antibodies were detected by commercial enzyme-linked immunosorbent assay. Multivariate Logistic regression was used to detect the independent risk factors for venous thrombosis.Results28 patients (10.4%) had venous thrombosis. Patients with venous thrombosis had higher levels of CHOL, LDL, and D-dimer than those without venous thrombosis (P<0.05). Patients with venous thrombosis had significantly lower levels of ALB (23.26 ± 5.24 vs. 26.00 ± 6.69 g/L, P=0.037). No significant differences were found in urine proteinuria, SCR, eGFR, platelets and fibrinogen between patients with and without thrombosis. Anti-PLA2R antibody levels in patients with venous thrombosis were significantly higher than in patients without it (P=0.010). In the univariate logistic regression, Ln PLA2R (OR: 1.316; P=0.032), ALB (OR: 0.932; P=0.039), CHOL (OR: 1.189, P=0.015) , and LDL (OR: 1.288，P=0.009) were associated with venous thrombosis. PLA2R-Ab (OR=1.316; 95%CI: 1.024~1.691), and LDL (OR=1.229; 95%CI: 1.012~1.493) were the independent risk factors for venous thrombosis (P<0.05) in multivariate analysis.ConclusionAnti-PLA2R antibody was the independent risk factor for venous thrombosis in PMN. Larger prospective studies were warranted to verify the results in future.

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To Analyze the Influencing Factors of Senile Coronary Heart Disease Patients Complicated with Frailty Syndrome

Journal of Healthcare Engineering ◽

10.1155/2022/7619438 ◽

2022 ◽

Vol 2022 ◽

pp. 1-6

Author(s):

Tian Qin ◽

Wang Sheng ◽

Guoheng Hu

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Logistic Regression ◽

Uric Acid ◽

Heart Disease ◽

Cell Count ◽

Influencing Factors ◽

Neutrophil Count ◽

Frailty Syndrome ◽

Multivariate Logistic Regression

To analyze the influencing factors of senile coronary heart disease patients complicated with frailty syndrome. A total of 80 elderly patients with coronary heart disease admitted to our hospital from March 2020 to March 2021 were selected as the research subjects. The Fried Frailty Symptom Scale was used to evaluate whether the 80 patients were complicated with frailty syndrome. According to the evaluation results, the patients were divided into a nonfrailty syndrome group (52 cases in total) and frailty syndrome group (28 cases in total). Clinical data of two groups of patients were collected, and multivariate logistic regression was used to analyze the influencing factors of senile coronary heart disease patients complicated with frailty syndrome. Among 80 patients, the incidence of frailty syndrome was 35.00% (28/80), including 18 cases in early frailty and 10 cases in frailty stage. Univariate analysis showed that age, body mass (BMI), diabetes mellitus, congestive heart failure, chronic renal insufficiency, chronic obstructive pulmonary disease (COPD), tumor, high uric acid hematic disease, arrhythmia, interleukin-6 (IL-6), c-reactive protein (CRP), fibrinogen (FIB), brain natriuretic peptide (BNP), uric acid (UA), serum creatinine (Scr), serum protein (ALB), white blood cell count (WBC), and neutrophil count were the possible risk factors for senile coronary heart disease complicated with frailty syndrome ( P < 0.05). Multivariate logistic regression analysis showed that combined COPD, combined tumor, IL-6, BNP, UA, SCR, ALB, and neutrophil count were independent risk factors for senile CHD complicated with frailty syndrome ( P < 0.05). Combined with COPD, combined with tumor, IL-6, BNP, UA, SCR, ALB, and neutron cell count are the influencing factors for senile coronary heart disease patients complicated with frailty syndrome. These factors can be used as the basis for the diagnosis of frailty syndrome and guide the clinical development of targeted diagnosis and treatment plan.

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Evaluation of stability of deep venous thrombosis of the lower extremities using Doppler ultrasound

Journal of International Medical Research ◽

10.1177/0300060520942098 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052094209

Author(s):

Shefang Zhang ◽

Wen Chu ◽

Hua Wang ◽

Yajun Liang ◽

Yajuan Fan ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Body Mass ◽

Doppler Ultrasound ◽

Area Under The Curve ◽

Lower Extremities ◽

Smoking History ◽

D Dimer

Objective This study aimed to assess using Doppler ultrasound for analyzing stability of deep venous thrombosis (DVT) of the lower extremities. Methods Patients with DVT of the lower extremities who were treated from August 2017 to December 2019 were selected. The patients were divided into stable and unstable groups according to whether thrombus was collected in a filter. Related ultrasound and blood test results were analyzed and compared. Results A total of 126 patients with DVT of the lower extremities were included, of whom 74 were in the stable group and 52 were in the unstable group. There were significant differences in the prothrombin time (PT), and lipoprotein alpha, D-dimer, and triglyceride levels between the groups. D-dimer levels >2800 ug/L, smoking, history of venous thrombosis, PT >13.15 s, and body mass index >24.45 kg/m2 were independent risk factors for stability of DVT of the lower extremities. The area under the curve with combined detection of DVT was significantly higher than that for body mass index, PT, and D-dimer alone. Conclusion Doppler ultrasound may be reliable for analyzing the stability of DVT of the lower extremities. Related strategies targeting risk factors are required for reducing DVT of the lower extremities.

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D-dimer, P-selectin, and microparticles: Novel markers to predict deep venous thrombosis

Thrombosis and Haemostasis ◽

10.1160/th05-06-0426 ◽

2005 ◽

Vol 94 (12) ◽

pp. 1312-1317 ◽

Cited By ~ 73

Author(s):

Daniel D. Myers ◽

Angela E. Hawley ◽

Christopher Longo ◽

Peter K. Henke ◽

Kenneth E. Guire ◽

...

Keyword(s):

Logistic Regression ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Total Protein ◽

Duplex Ultrasound ◽

Group 3 ◽

Soluble P ◽

Group 2 ◽

D Dimer ◽

Plasma Markers

SummaryCurrent plasma markers for diagnosis of deep venous thrombosis (DVT) allow for exclusion of the diagnosis, but lack adequate specificity to establish the diagnosis. Thus, a prospective study was performed to determine the sensitivity and specificity of plasma assays for D-dimer, soluble P-selectin (P-selectin), and total microparticles in patients with documented DVT by duplex ultrasound. Three groups of individuals were examined: 30 normals; 22 positive for DVT on duplex ultrasound (Group 2); and 21 symptomatic, but negative on duplex ultrasound for DVT (Group 3). Group 1 individuals had D-dimer values of 1.53±0.12 mg/l and P-selectin values of 0.34±0.05 ng/mg total protein. Group 2 vs. Group 3 individuals had D-dimer values of 7.57±2.03 vs. 3.19±0.79 mg/l, p=0.02; P-selectin values of 0.98±0.11 vs. 0.55±0.08 ng/mg total protein, p<0.01; and microparticle values of 129±17% vs. 99±12% of control, p=ns. Using a logistic regression model with dichotomous variables, we determined a sensitivity of 73%, specificity of 81%, and accuracy of 77% when combining D-dimer, soluble P-selectin, and total microparticles to differentiate Group 2 from Group 3 patients. Logistic regression using continuous variables yielded similar results (p=0.05).This study demonstrates that plasma markers for DVT can be developed and achieve moderate sensitivity and specificity in diagnosing DVT. However for clinical applicability, the sensitivity/specificity will need to be improved. These studies also suggest the importance of soluble P-selectin in assessing DVT in humans.

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Clinical Risk Factors of Asymptomatic Deep Venous Thrombosis in Patients With Acute Stroke

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029619868534 ◽

2019 ◽

Vol 25 ◽

pp. 107602961986853

Author(s):

Yi Wang ◽

Yu Shi ◽

Yi Dong ◽

Qiang Dong ◽

Ting Ye ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Acute Stroke ◽

Area Under The Curve ◽

High Risk Population ◽

Observation Study ◽

Kaplan Meier ◽

D Dimer

Background: Deep venous thrombosis (DVT) is a common complication after stroke. It is easy to identify the patients with symptomatic DVT; however, the tool for asymptomatic high-risk population needs to be further explored. Our aim was to explore the risk factors of acute stroke patients with asymptomatic DVT. Methods: We performed a prospective observation study among 452 patients with acute stroke who had a stroke within 14 days. Ultrasound examination of deep veins was repeatedly performed in each patient for DVT every 7 days during his admission. The dynamic rate of DVT in acute stroke was analyzed. Then risk factors were compared between DVT patients and non-DVT patients. The predictive model was explored based on thr cox proportion model. Results: Asymptomatic DVT was detected in 52 (11.5%) patients with stroke and 85.9% of thrombi were identified in their distal veins. Patients with longer length of stay ( P = .004), more severe stroke ( P = 0.001), higher level of D-dimer ( P = .003), and higher blood glucose level were associated with higher risk of DVT, while patients with higher triglyceride level ( P = .003) were less likely to have DVT, after adjusting age and sex. With the median of D-dimer (0.38 FEU mg/L) as cutoff value. Patients with higher level of D-dimer might have a higher risk of DVT with a significant statistical difference. Also, the severity of stroke differed DVT risk in Kaplan-Meier model. Using cox-proportion hazard regression model, asymptomatic DVT could be predicted (area under the curve 0.852). Conclusion: Our data showed that asymptomatic DVT was common in patients with acute stroke and most of thrombosis occurred in distal veins. Combination of clinical manifestation and laboratory results might be helpful predict DVT. DVT prophylaxis should be condisdered in high risk.

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Prevalence and risk factors of preoperative deep venous thrombosis in closed patella fracture: a prospective cohort study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02558-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zhanchao Tan ◽

Hongzhi Hu ◽

Zhongzheng Wang ◽

Yuchuan Wang ◽

Yingze Zhang

Keyword(s):

Risk Factors ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Study Cohort ◽

Patella Fracture ◽

Total Hospital Stay ◽

Stay Time ◽

Independent Risk Factors ◽

Associated Risk Factors ◽

D Dimer

Abstract Background The preoperative prevalence of deep venous thromboembolism (DVT) of patella fracture is not well established. The study aimed to investigate the preoperative prevalence, the associated risk factors, and the locations of deep venous thrombosis (DVT) in patients with closed patella fracture. Methods Patients who sustained closed patella fracture between January 1, 2016, and April 1, 2019, were included. Blood analyses and ultrasonography of bilateral lower extremities were routinely performed. Data of demographics, comorbidities, mechanism of injury, fracture type, total hospital stay, time from injury to DVT, and laboratory indexes were prospectively collected and compared between groups with and with non-DVT. Multivariate logistic regression analyses were performed to determine the independent risk factors of DVT. Results Among the study cohort of 790 patients, 35 cases occurred in preoperative DVTs, indicating a prevalence of 4.4%, with 3.2% distal and 1.2% proximal DVT. Age ≥ 65 years old (OR, 3.0, 95% CI, 1.1–8.1), D-dimer > 0.5 mg/L (OR, 2.3, 95% CI, 1.1–4.8), and albumin < 35 g/L (OR, 2.5, 95% CI, 1.2–5.3) were identified to be risk factors of DVT in closed patella fracture. Among the DVTs, 30 cases (85.7%) occurred in the injured extremity, 3 cases (8.6%) in bilateral extremities, and 2 cases (5.7%) solely in the uninjured extremity. Conclusion The prevalence of preoperative DVT in closed patella fracture was 4.4%, with 3.2% for distal and 1.2% for proximal DVT. We recommend individualized risk stratification and early anticoagulation for patients with risk factors (age ≥ 65 years, D-dimer > 0.5 mg/L and albumin < 35g/L).

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Pulmonary embolism secondary to deep venous thrombosis: A retrospective and observational study for clinical characteristics and risk stratification

Phlebology The Journal of Venous Disease ◽

10.1177/0268355521990964 ◽

2021 ◽

pp. 026835552199096

Author(s):

Xiaoying Chen ◽

Xian Liu ◽

Jinglun Liu ◽

Dan Zhang

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Scoring System ◽

Previous History ◽

Previous Surgery ◽

Significant Difference ◽

Independent Risk Factors ◽

D Dimer

Objective To investigate the risk factors, predilection sites in pulmonary embolism (PE) patients caused by deep venous thrombosis (DVT) and explore the value of scoring systems in assessing the risk of PE in DVT patients. Methods A total of 692 DVT patients were enrolled, and divided into no pulmonary embolism (NPE, 226, 32.66%), silent pulmonary embolism (SPE, 330, 47.67%) and featuring pulmonary embolism (FPE, 136, 19.65%) groups. For each group, the differences of clinical data and PE locations were compared, and the risk factors of PE secondary to DVT were analyzed. The predictive value of the scoring system for the diagnosis of PE and FPE was evaluated. Results PE presented more in the bilateral pulmonary arteries (PAs) (249, 53.43%) and has no significant difference in PESI scores in different locations. Gender, DVT locations, and previous surgery were the independent risk factors of PE. DVT locations, previous history of COPD, and previous surgical interventions were the independent risk factors of FPE. The results for areas under the ROC curves were: AUC(Wells) = 0.675, AUC (Revised Geneva) = 0.601, AUC(D-dimer) = 0.595 in the PE group; AUC(Wells) = 0.722, AUC (Revised Geneva) = 0.643, AUC(D-dimer) = 0.557 in the FPE group. Conclusions PE secondary to DVT mostly occurs in the bilateral PAs. Male gender, DVT locations, and previous surgery increased the risk of PE. The Wells scoring system was more advantageous for evaluating the diagnosis of PE in patients with DVT.

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Utilization of Thromboelastogram and Inflammatory Markers in the Management of Hypercoagulable State in Patients with COVID-19 Requiring ECMO Support

Case Reports in Critical Care ◽

10.1155/2021/8824531 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Angela Smolarz ◽

Paul McCarthy ◽

Aaron Shmookler ◽

Vinay Badhwar ◽

Awori J. Hayanga ◽

...

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Inflammatory Markers ◽

Anticoagulation Therapy ◽

Duplex Ultrasound ◽

Ecmo Support ◽

Hypercoagulable State ◽

Successful Management ◽

Venovenous Ecmo ◽

D Dimer

The role of extracorporeal membrane oxygenation (ECMO) in the management of critically ill patients with COVID-19 is evolving. Extracorporeal support independently confers an increased predilection for thrombosis, which can be exacerbated by COVID-19-associated coagulopathy. We present the successful management of a hypercoagulable state in two patients who required venovenous ECMO for the treatment of COVID-19. This included monitoring inflammatory markers (D-dimer and fibrinogen), performing a series of therapeutic plasma exchange procedures, and administering high-intensity anticoagulation therapy and thromboelastography- (TEG-) guided antiplatelet therapy. TPE was performed to achieve goal D-dimer less than 3000 ng/mL D-dimer units ( N ≤ 232 ng / mL D-dimer units) and goal fibrinogen less than 600 mg/dL ( N = 200 -400 mg/dL). These therapies resulted in improved TEG parameters and normalized inflammatory markers. Patients were decannulated after 37 days and 21 days, respectively. Post-ECMO duplex ultrasound of the upper and lower extremities and cannulation sites revealed a nonsignificant deep venous thrombosis at the site of femoral cannulation in patient 2 and no deep venous thrombosis in patient 1. The results of this case report show successful management of a hypercoagulable state among COVID-19 patients requiring ECMO support by utilization of inflammatory markers and TEG.

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

Frontiers in Surgery ◽

10.3389/fsurg.2021.671165 ◽

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 < 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.

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