Prevalence of Low Limb Venous Thromboembolic Events in Mild and Severe/Critically Ill Patients with COVID-19 Despite Pharmacological Thromboprophylaxis

Background:The prevalence of deep vein thrombosis in hospitalized patients with COVID-19 is higher and is associated with adverse outcomes. However, the treatment options received by patients with different classifications are different, and previous studies have not discussed the differences in specific coagulation parameters between patients with mild, severe, and critically ill COVID-19. Aim:To investigate the change in coagulation function and the incidence of low limb venous thromboembolic events in mild/severe/critically ill patients with COVID-19. Methods:A retrospective analysis of coagulation parameters and lower extremity venous ultrasound examination results in 77 patients with laboratory-confirmed COVID-19 admitted to the first affiliated hospital of Harbin Medical University. We discussed the occurrence of vascular complications in patients with normal, severe and critically ill patients Rate and explore the nature of such vascular events. The anticoagulation dose was left to the discretion of the treating physician based on the individual risk of thrombosis and patients were classified as treated with prophylactic anticoagulation or therapeutic anticoagulation. Approval was obtained from the local institutional review board and all procedures were performed in accordance with the Declaration of Helsinki. Results:The incidence of low limb venous thromboembolic events in COVID-19 patients included in the study was 28.6% (22/77). A total of 22 cases with deep vein thrombosis, 13 of whom with multiple thrombosis events, and 9 cases with independent distal deep vein thrombosis. There were 0 cases, 8 cases (17.4%) and 14 cases (87.5%) of patients with deep vein thrombosis occurred in mild, severe and critically ill patients, respectively. There were 4 cases (50%) and 9 cases (64.29%) of severe and critically ill patients with multiple deep vein thrombosis events, respectively. There was no difference in age and gender between patients with lower extremity venous thrombosis and those without. The mortality rate of patients with thrombotic events has an upward trend; the mortality rate of patients with thrombosis is 18.18%, and the mortality rate of patients without thrombosis is 3.64%. Compared with mild patients, white blood cell counts, neutrophil percentage, fibrinogen, IL-6, IL-10 serum levels are higher in severe and critically ill patients. The patients whose ultrasonography reported thrombosis mostly showed a dynamic increase and/or a significant increase in D-dimer. The patients whose ultrasonography reported no thrombosis showed mildly elevated D-dimer or within the normal range. Conclusions:The development of massive venous thrombotic events, as observed in our study cohort, suggests the possibility of COVID-19 associated hypercoagulability and endothelial activation and/or dysfunction in affected individuals. Figure Disclosures No relevant conflicts of interest to declare.

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Predicting Venous Thromboembolic Events in Patients with Coronavirus Disease 2019 Requiring Hospitalization: an Observational Retrospective Study by the COVIDIC Initiative in a Swiss University Hospital

BioMed Research International ◽

10.1155/2020/9126148 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

Eleftheria Kampouri ◽

Paraskevas Filippidis ◽

Benjamin Viala ◽

Marie Méan ◽

Olivier Pantet ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Retrospective Study ◽

University Hospital ◽

Thromboembolic Events ◽

Vein Thrombosis ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Wells Score ◽

Deep Vein ◽

D Dimer

Background. Coronavirus disease 2019 (COVID-19) can result in profound changes in blood coagulation. The aim of the study was to determine the incidence and predictors of venous thromboembolic events (VTE) among patients with COVID-19 requiring hospital admission. Subjects and Methods. We performed a retrospective study at the Lausanne University Hospital with patients admitted because of COVID-19 from February 28 to April 30, 2020. Results. Among 443 patients with COVID-19, VTE was diagnosed in 41 patients (9.3%; 27 pulmonary embolisms, 12 deep vein thrombosis, one pulmonary embolism and deep vein thrombosis, one portal vein thrombosis). VTE was diagnosed already upon admission in 14 (34.1%) patients and 27 (65.9%) during hospital stay (18 in ICU and nine in wards outside the ICU). Multivariate analysis revealed D-dimer value > 3,120 ng / ml ( P < 0.001 ; OR 15.8, 95% CI 4.7-52.9) and duration of 8 days or more from COVID-19 symptoms onset to presentation ( P 0.020; OR 4.8, 95% CI 1.3-18.3) to be independently associated with VTE upon admission. D-dimer value ≥ 3,000 ng / l combined with a Wells score for PE ≥ 2 was highly specific (sensitivity 57.1%, specificity 91.6%) in detecting VTE upon admission. Development of VTE during hospitalization was independently associated with D-dimer value > 5,611 ng / ml ( P < 0.001 ; OR 6.3, 95% CI 2.4-16.2) and mechanical ventilation ( P < 0.001 ; OR 5.9, 95% CI 2.3-15.1). Conclusions. VTE seems to be a common COVID-19 complication upon admission and during hospitalization, especially in ICU. The combination of Wells ≥ 2 score and D − dimer ≥ 3,000 ng / l is a good predictor of VTE at admission.

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Recurrence of Upper Extremity Deep Vein Thrombosis Secondary to COVID-19

Viruses ◽

10.3390/v13050878 ◽

2021 ◽

Vol 13 (5) ◽

pp. 878

Author(s):

Yesha H. Parekh ◽

Nicole J. Altomare ◽

Erin P. McDonnell ◽

Martin J. Blaser ◽

Payal D. Parikh

Keyword(s):

Deep Vein Thrombosis ◽

Lower Extremity ◽

Upper Extremity ◽

Thromboembolic Events ◽

Vein Thrombosis ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic ◽

Deep Vein

Infection with SARS-CoV-2 leading to COVID-19 induces hyperinflammatory and hypercoagulable states, resulting in arterial and venous thromboembolic events. Deep vein thrombosis (DVT) has been well reported in COVID-19 patients. While most DVTs occur in a lower extremity, involvement of the upper extremity is uncommon. In this report, we describe the first reported patient with an upper extremity DVT recurrence secondary to COVID-19 infection.

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The Impact of Deep Vein Thrombosis on Outcomes in Critically Ill Patients: A Systematic Review and Meta-Analysis

Blood ◽

10.1182/blood.v112.11.3023.3023 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3023-3023

Author(s):

Alessandra Malato ◽

Wendy Lim ◽

Sergio Siragusa ◽

Deborah Cook ◽

Mark A. Crowther

Keyword(s):

Systematic Review ◽

Mechanical Ventilation ◽

Deep Vein Thrombosis ◽

Mortality Rate ◽

Hospital Mortality ◽

Critically Ill ◽

Critically Ill Patients ◽

Icu Mortality ◽

Vein Thrombosis ◽

Deep Vein

Abstract Background: The clinical consequences of Deep Vein Thrombosis (DVT) have the potential to be serious yet are frequently unrecognized in the Intensive Care Unit (ICU). We hypothesized that both undetected and clinically evident VTE would affect the prognosis of critically ill patients Purpose: To systematically review whether a diagnosis of DVT in critically ill patients affects clinically important outcomes including length of stay, duration of mechanical ventilation and mortality. Material and Methods: Data sources used were the MEDLINE, EMBASE and PUBMED databases. Studies selected evaluated one or more of the following outcomes: duration of patient stay in hospital and in ICU, hospital and ICU mortality, and duration of mechanical ventilation. Two investigators independently extracted and reviewed data from each study; including study and patient characteristics and outcomes. Statistical heterogeneity was evaluated using the I2 statistic; Cohen’s Kappa for inter-rater agreement was used to assess inter-rater reliability. Data was pooled using the Mantel-Haenszel method and a random effects model using Review Manager. Results: Five studies were included in the systematic review. Patients diagnosed with DVT compared to those without DVT had increased ICU and hospital stay (7.3 days (95% confidence interval [CI] 1.4 to 13.2; P= 0.02) and 16.5 days (95% CI 1.51 to 30.59; P= 0.03), respectively. Duration of mechanical ventilation was increased by 3.41 days (95 % CI −1.12 to 7.94; P=0.14). Patients diagnosed with DVT also had increased relative risk (RR) for ICU mortality of 9.19 (95% CI 1.07 to 78.65, P=0.04) and a trend towards increased hospital mortality (RR 14.32 [95% CI 0.59 to 347.96, P = 0.10]). Conclusions: A diagnosis of DVT upon ICU admission appears to affect clinically important outcomes including length of ICU and hospital stay and ICU mortality. Further research involving larger prospective study designs are warranted. Outcomes Study Duration of mechanical ventilation in days (DVT/NO DVT) Hospitalization length In days (DVT/NO DVT) ICU Stay In days (DVT/NO DVT) Hospital mortality rate (DVT/NO DVT) n (%) ICU mortality rate (DVT, n/NO DVT, n) Legend PEPP: positive end-expiratory pressur * IQR ** median “ [95%CI]) ^ Necessity for ventilation measured by PEEP ≥10: DVT/no DVT: 11 (42%)/37 (21%) Ibrahim  2002 18.9±19.7/14.6±12.9M  p=0.310 31.4±21.7/27.5± 18.2  p=0.375 18.6±14.6/15.9±1.04  p=0.388 8.9 (34.6%)/26.8(32.1)  p=0.815 n/a Velmahos  1998 Not given. ^ 49±32/31±24, p=< 0.05 34±31/19±18, p=<0.05 n/a 31%,8.06/18%,31.2 Major  2003 n/a n/a n/a n/a 17%, 2/2%, 15  p=0.03 Patel  2005 n/a 26**  (14,49)*/− 6**  (3,15)*/− 70**  (28.5%) [22.8–34.1])″/− 16.7%,41 [12.0- 21.3]″/− Cook  2005 9** (4,25)*/6 (3,13)*   p=0.03 51** (24,73)*/23 **  (12,47)*  p=<0.001 17.5** (8.5, 30.5)*/9** (5,17)* 17 (53.1%)/85  (37.4%)  p=0.04 -, 8 **/−, 62**  p=0.78

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Faculty Opinions recommendation of Prophylaxis against deep vein thrombosis in critically ill patients with severe renal insufficiency with the low-molecular-weight heparin dalteparin: an assessment of safety and pharmacodynamics: the DIRECT study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1124847.581938 ◽

2008 ◽

Author(s):

Mark Hamilton ◽

Marcus Peck

Keyword(s):

Molecular Weight ◽

Deep Vein Thrombosis ◽

Renal Insufficiency ◽

Critically Ill ◽

Critically Ill Patients ◽

Low Molecular Weight Heparin ◽

Low Molecular Weight ◽

Vein Thrombosis ◽

Severe Renal Insufficiency ◽

Deep Vein

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Prevalence and risk factors for venous thromboembolic events in critically ill patients with SARS-CoV-2 infection: a prospective observational study

Minerva Anestesiologica ◽

10.23736/s0375-9393.21.15510-5 ◽

2021 ◽

Author(s):

Alessandro F. CHIESA ◽

Marco PREVISDOMINI ◽

Elisa VALENTI ◽

Elisa STOIRA ◽

Hans STRICKER ◽

...

Keyword(s):

Risk Factors ◽

Observational Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Prospective Observational Study ◽

Thromboembolic Events ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic

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Diagnostic Strategies for Deep Vein Thrombosis (DVT) in Critically Ill Patients: A Cost-Utility Analysis.

10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a3306 ◽

2009 ◽

Author(s):

S Sud ◽

B Chan ◽

N Mittman ◽

B Geerts ◽

R Fowler

Keyword(s):

Deep Vein Thrombosis ◽

Critically Ill ◽

Critically Ill Patients ◽

Cost Utility ◽

Cost Utility Analysis ◽

Utility Analysis ◽

Diagnostic Strategies ◽

Vein Thrombosis ◽

Deep Vein

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Safety of a strategy combining D-dimer testing and whole-leg ultrasonography to rule out deep vein thrombosis

Blood Advances ◽

10.1182/bloodadvances.2020002173 ◽

2020 ◽

Vol 4 (20) ◽

pp. 5002-5010

Author(s):

Synne G. Fronas ◽

Camilla T. Jørgensen ◽

Anders E. A. Dahm ◽

Hilde S. Wik ◽

Jostein Gleditsch ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Pretest Probability ◽

Vein Thrombosis ◽

Venous Thromboembolic ◽

Deep Vein ◽

D Dimer ◽

Rule Out ◽

Compression Ultrasonography ◽

High Pretest Probability

Abstract Guidelines for the diagnostic workup of deep vein thrombosis (DVT) recommend assessing the clinical pretest probability before proceeding to D-dimer testing and/or compression ultrasonography (CUS) if the patient has high pretest probability or positive D-dimer. Referring only patients with positive D-dimer for whole-leg CUS irrespective of pretest probability may simplify the workup of DVT. In this prospective management outcome study, we assessed the safety of such a strategy. We included consecutive outpatients referred to the Emergency Department at Østfold Hospital, Norway, with suspected DVT between February 2015 and November 2018. STA-Liatest D-Di Plus D-dimer was analyzed for all patients, and only patients with levels ≥0.5 µg/mL were referred for CUS. All patients with negative D-dimer or negative CUS were followed for 3 months to assess the venous thromboembolic rate. One thousand three hundred ninety-seven patients were included. Median age was 64 years (interquartile range, 52-73 years), and 770 patients (55%) were female. D-dimer was negative in 415 patients (29.7%) and positive in 982 patients (70.3%). DVT was diagnosed in 277 patients (19.8%). Six patients in whom DVT was ruled out at baseline were diagnosed with DVT within 3 months of follow-up for a thromboembolic rate of 0.5% (95% confidence interval, 0.2-1.2). A simple diagnostic approach with initial stand-alone D-dimer followed by a single whole-leg CUS in patients with positive D-dimer safely ruled out DVT. We consider this strategy to be a valuable alternative to the conventional workup of DVT in outpatients. This trial was registered at www.clinicaltrials.gov as #NCT02486445.

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