Clinical Characteristics of Venous Thromboembolism in COVID-19 Patients Admitted to intensive care unit

Abstract Introduction: COVID-19 infection was associated with many morbid conditions, one of which is venous thromboembolism; however, this is varied in incidence and clinical characteristics, with no known definite risk predictors.Aim: To identify the incidence, clinical characteristics, and risks and outcome of venous thromboembolism in COVID-19 patients.Methods: a retrospective cohort study comparing the recorded data for two groups of patients with confirmed COVID-19 infection and admitted to the ICU in 6 months duration.Results: the incidence of venous thromboembolism was 30%, where pulmonary embolism (PE) alone was the most frequent type (68.2%), followed by, DVT with PE (15.1%), DVT alone (12.1%), cavernous sinus thrombosis alone CST (3%) and the least frequency was CST with renal artery thrombi (1.5%). Smoking and malignancy were more frequent in VTE group with more statistically significant elevation of D dimer. the pulmonary embolism was lobar in the majority of our patients (69.6%), followed by segmental (17.9%), while the least frequency was for massive pulmonary embolism (12.5%).Conclusion: VTE is a common event in COVID-19 patients, where smoking and malignancy more frequent, D dimer is significantly elevated, and more morbidity and mortality in those patients.

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Karakteristik Klinis Pasien Trombosis Sinus Venosus Serebral (TSVS) di Ruang Rawat Inap Neurologi Rumah Sakit Hasan Sadikin Bandung

Jurnal Neuroanestesi Indonesia ◽

10.24244/jni.v9i2.244 ◽

2020 ◽

Vol 9 (2) ◽

pp. 71-7

Author(s):

Lisda Amalia

Keyword(s):

General Hospital ◽

Clinical Manifestation ◽

Clinical Characteristics ◽

Sinus Thrombosis ◽

Clinical Manifestations ◽

Transverse Sinus ◽

Sinus Venosus ◽

Cortical Vein ◽

Sinus Transversus ◽

D Dimer

Latar Belakang dan Tujuan: Trombosis sinus venosus serebral (TSVS) merupakan penyakit akibat oklusi struktur vena intrakranial, termasuk sinus serebral, vena korteks, dan bagian proksimal vena jugularis. Keterlambatan diagnosis dan terapi dapat mengakibatkan terjadinya komplikasi seperti infark berdarah bahkan kematian.Tujuan penelitian ini adalah untuk mengetahui karakteristik klinis pasien TSVS yang diagnosisnya telah dikonfirmasi melalui pemeriksaan DSA. Metode: Penelitian ini bersifat deskriptif observasional retrospektif. Pada pasien yang telah didiagnosis TSVS di Bagian Neurologi Rumah Sakit Hasan Sadikin Bandung periode Juni 2015 sampai November 2017.Hasil: Terdapat 33 subjek dengan rentang usia 40-49 tahun (24,2%) dan mayoritas adalah perempuan sebanyak 22 orang (66,7%). Faktor resiko terbanyak adalah infeksi 8 orang (24,2%), dan kondisi protrombotik sebanyak 6 orang (18,2%). Gejala klinis terbanyak adalah nyeri kepala yaitu 27 orang (81,8%). Lokasi sinus yang tersering mengalami trombosis adalah sinus transversus pada 28 orang dengan gejala mayoritas nyeri kepala. Kadar D-Dimer ditemukan meningkat dengan rata-rata 1,21 mg/L.Simpulan: Pasien TSVS terjadi pada perempuan dengan rentang usia dekade pertengahan dan faktor resiko terbanyak adalah infeksi. Nyeri kepala merupakan gejala paling sering. Lokasi trombosis mayoritas terjadi pada sinus transversus dan ditemukan peningkatan D-Dimer. Clinical Characteristics of Cerebral Venous Sinus Thrombosis (CVST) Patients in Neurology Ward Hasan Sadikin General Hospital BandungAbstractBackground and Objective: CVST is an entity caused by intracranial vein, including cerebral sinuses, cortical vein and proximal part of the jugular vein. A delay in diagnosing and treating can result in brain infarct with hemorrhagic transformation, even death. The goal of this study is to learn the clinical characteristics of patients with CVST that had been confirmed by DSA.Method: This was a retrospective observational descriptive study and subjects were hospitalized patients which had been diagnosed CVST in Neurology ward Hasan Sadikin General Hospital from June 2015 to November 2017.Results: there was 33 subjects with most (22 patient/66.7%) being women between 40-49 years old. In this study the most frequently found risk factor was infection in 8 subjects (24.2%), prothrombotic conditions in 6 subjects (18.2%). The clinical manifestations were mainly headache in 27 subjects (81,8%). The sinus most often involved was the transverse sinus (28 subjects) with the clinical manifestation being headache. D-dimer levels were also increased with mean 1.21 mg/dl.Conclusion: CVST patients are mostly in women at the midle age of decade, with infection being the most frequent risk. Headache was the most frequent clinical manifestation. Location of thrombosis were more often found on the transverse sinus and D-Dimer level was increased.

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Venous Thromboembolism

10.2310/fm.1102 ◽

2020 ◽

Author(s):

Samuel Z. Goldhaber

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Antithrombotic Agents ◽

Vein Thrombosis ◽

Recurrent Venous Thrombosis ◽

Deep Vein ◽

D Dimer ◽

In Pregnancy

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites). This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

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Advances in the Diagnosis of Venous Thromboembolism: A Literature Review

Diagnostics ◽

10.3390/diagnostics10060365 ◽

2020 ◽

Vol 10 (6) ◽

pp. 365 ◽

Cited By ~ 3

Author(s):

Harish Patel ◽

Haozhe Sun ◽

Ali N. Hussain ◽

Trupti Vakde

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Valsalva Maneuver ◽

Imaging Modality ◽

Diagnostic Algorithm ◽

Pulmonary Angiography ◽

Vein Thrombosis ◽

Compression Ultrasound ◽

Test Probability ◽

D Dimer

The incidence of venous thromboembolism (VTE), including lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE) is increasing. The increase in suspicion for VTE has lowered the threshold for performing imaging studies to confirm diagnosis of VTE. However, only 20% of suspected cases have a confirmed diagnosis of VTE. Development of pulmonary embolism rule-out criteria (PERC) and update in pre-test probability have changed the paradigm of ruling-out patient with low index of suspicion. The D-dimer test in conjunction to the pre-test probability has been utilized in VTE diagnosis. The age appropriate D-dimer cutoff and inclusion of YEARS algorithm (signs of the DVT, hemoptysis and whether PE is the likely diagnosis) for the D-dimer cutoff have been recent updates in the evaluation of suspected PE. Multi-detector computed tomography pulmonary angiography (CTPA) and compression ultrasound (CUS) are the preferred imaging modality to diagnose PE and DVT respectively. The VTE diagnostic algorithm do differ in pregnant individuals. The prerequisite of avoiding excessive radiation has recruited planar ventilation-perfusion (V/Q) scan as preferred in pregnant patients to evaluate for PE. The modification of CUS protocol with addition of the Valsalva maneuver should be performed while evaluating DVT in pregnant individual.

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Performance of a diagnostic algorithm based on a prediction rule, D-dimer and CT-scan for pulmonary embolism in patients with previous venous thromboembolism

Thrombosis and Haemostasis ◽

10.1160/th14-06-0488 ◽

2015 ◽

Vol 113 (02) ◽

pp. 406-413 ◽

Cited By ~ 15

Author(s):

Paul L. den Exter ◽

Inge C. M. Mos ◽

Menno V. Huisman ◽

Frederikus A. Klok ◽

Maria José Fabiá Valls ◽

...

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Random Effect ◽

Prediction Rule ◽

Diagnostic Algorithm ◽

Clinical Prediction Rule ◽

Incidence Rates ◽

Specific Patient ◽

History Of ◽

D Dimer

SummaryDiagnostic management of suspected pulmonary embolism (PE) in patients with a history of venous thromboembolism (VTE) is complicateddue to persistent abnormal D-dimer levels, residual embolic obstruction and higher clinical prediction rule (CPR) scores. We aimed to evaluate the safety and efficiency of the standard diagnostic algorithm consisting of a CPR, D-dimer test and computed tomography pulmonary angiography (CTPA) in this specific patient category. We performed a systematic literature search for prospective studies evaluating a diagnostic algorithm in consecutive patients with clinically suspected PE and a history of VTE. The VTE incidence rates during three-month follow-up and the number of indicated CTPAs were pooled using random effect models. Four studies concerning 1,286 patients were included with a pooled baseline PE prevalence of 36 % (95 % confidence interval [CI] 30–42). In only 217 patients (15 %; 95 %CI 11–20) PE could be excluded without CTPA. The three-month VTE incidence rate was 0.8 % (95 %CI 0.06–2.4) in patients managed without CTPA, 1.6 % (95 %CI 0.3–4.0) in patients in whom PE was excluded by CTPA and 1.4 % (95 %CI 0.6–2.7) overall. In the pooled studies, PE was safely excluded in patients with a history of VTE based on a CPR followed by a D-dimer test and/or CTPA, although the efficiency of the algorithm is relatively low compared to patients without a history of VTE.

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Comparison of clinical probability-adjusted D-dimer and age-adjusted D-dimer interpretation to exclude venous thromboembolism

Thrombosis and Haemostasis ◽

10.1160/th17-03-0182 ◽

2017 ◽

Vol 117 (10) ◽

pp. 1937-1943 ◽

Cited By ~ 9

Author(s):

Jim Julian ◽

Lori-Ann Linkins ◽

Shannon Bates ◽

Clive Kearon ◽

Sarah Takach Lapner

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Diagnostic Accuracy ◽

Blood Samples ◽

Vein Thrombosis ◽

Clinical Probability ◽

Deep Vein ◽

New Strategies ◽

D Dimer

SummaryTwo new strategies for interpreting D-dimer results have been proposed: i) using a progressively higher D-dimer threshold with increasing age (age-adjusted strategy) and ii) using a D-dimer threshold in patients with low clinical probability that is twice the threshold used in patients with moderate clinical probability (clinical probability-adjusted strategy). Our objective was to compare the diagnostic accuracy of age-adjusted and clinical probability-adjusted D-dimer interpretation in patients with a low or moderate clinical probability of venous thromboembolism (VTE). We performed a retrospective analysis of clinical data and blood samples from two prospective studies. We compared the negative predictive value (NPV) for VTE, and the proportion of patients with a negative D-dimer result, using two D-dimer interpretation strategies: the age-adjusted strategy, which uses a progressively higher D-dimer threshold with increasing age over 50 years (age in years × 10 µg/L FEU); and the clinical probability-adjusted strategy which uses a D-dimer threshold of 1000 µg/L FEU in patients with low clinical probability and 500 µg/L FEU in patients with moderate clinical probability. A total of 1649 outpatients with low or moderate clinical probability for a first suspected deep vein thrombosis or pulmonary embolism were included. The NPV of both the clinical probability-adjusted strategy (99.7%) and the age-adjusted strategy (99.6%) were similar. However, the proportion of patients with a negative result was greater with the clinical probability-adjusted strategy (56.1% vs, 50.9%; difference 5.2%; 95% CI 3.5% to 6.8%). These findings suggest that clinical probability-adjusted D-dimer interpretation is a better way of interpreting D-dimer results compared to age-adjusted interpretation.

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Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2006.03.023 ◽

2006 ◽

Vol 31 (1) ◽

pp. 124-125

Author(s):

Todd Clever

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

D Dimer

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Clinical characteristics and outcomes of patients with venous thromboembolism according to diagnosis on weekends versus weekdays: from the COMMAND VTE Registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.2280 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Y Yamashita ◽

T Morimoto ◽

T Makiyama ◽

K Ono ◽

T Kimura

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Clinical Outcomes ◽

Clinical Characteristics ◽

Anticoagulation Therapy ◽

Treatment Strategies ◽

Funding Source ◽

Medical Systems ◽

Severe Condition ◽

Entire Cohort

Abstract Background/Introduction The medical systems of hospitals often differs between on weekends and weekdays. These differences could lead different clinical outcomes for patients with acute medical conditions that require complex treatment strategies. However, the effect of the time of diagnosis on clinical outcomes in patients with acute venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is still controversial. Purpose We sought to evaluate the clinical characteristics and outcomes of patients with VTE comparing on weekends and weekdays in a large observational database of VTE in Japan. Methods The COMMAND VTE Registry is a multicenter registry enrolling 3027 consecutive patients with acute symptomatic VTE objectively confirmed by imaging examination or by autopsy among 29 centers in Japan between January 2010 and August 2014. In the current analysis, diagnosis on weekends was defined as diagnosis during the period from 00:00 hours on Saturday to 24:00 on Sunday. All other times were defined as weekdays. We divided the entire cohort into 2 groups; diagnosis on weekends and diagnosis on weekdays groups, and we compared the clinical characteristics, management strategies and 30-day outcomes between the 2 groups. Results The current study population consisted of 337 patients diagnosed on weekends and 2690 patients diagnosed on weekdays. The median days from onset to diagnosis were shorter in the patients diagnosed on weekends than in those diagnosed on weekdays (2 days vs. 4 days, P<0.001). The patients diagnosed on weekends presented with PE more frequently (72% vs. 55%, P<0.001), and they showed more severe condition for PE with a higher simplified pulmonary embolism severity index score. The vast majority of PE patients were diagnosed by contrast-enhanced computed tomography in both groups (97% vs. 97%, P=0.67). The patients diagnosed on weekends more often received initial parenteral anticoagulation therapy and thrombolysis than those diagnosed on weekdays. The cumulative 30-day incidence of all-cause death was not significantly different between the 2 groups among PE patients (diagnosis on weekends: 6.2% vs. diagnosis on weekdays: 6.5%, P=0.87), as well as among DVT patients (0.0% vs. 1.5%, P=0.24) (Figure). After adjusting the confounders, the risk of diagnosis on weekends relative to diagnosis on weekdays for all-cause death among PE patients was still insignificant (adjusted HR: 0.76; 95% CI: 0.42–1.28). The most frequent cause of deaths was fatal PE in both groups among PE patients. The risks for recurrent VTE and major bleeding at 30 days were not significantly different between the 2 groups among PE patients nor DVT patients. Conclusions The VTE patients diagnosed on weekends presented with PE more frequently, and they showed more severe condition for PE, although the risks for short-term mortality were not significantly different between patients diagnosed on weekends and weekdays. Kaplan-Meier curves for all-cause death Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation

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Efficacy and safety of apixaban in patients with active malignancy and acute deep venous thrombosis

Vascular ◽

10.1177/1708538120971148 ◽

2020 ◽

pp. 170853812097114

Author(s):

Mostafa El Mokadem ◽

Ahmed Hassan ◽

Abdulaziz Z Algaby

Keyword(s):

Molecular Weight ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Major Bleeding ◽

Low Molecular Weight Heparin ◽

Massive Pulmonary Embolism ◽

Low Molecular Weight ◽

Efficacy And Safety

Objectives Low-molecular weight heparin (LMWH) has been approved for treatment of deep venous thrombosis and venous thromboembolism which are associated with cancer. The efficacy and safety of apixaban in management of acute deep venous thrombosis associated with active malignancy is still an unresolved issue. The aim of our study is to evaluate the efficacy and safety of apixaban in patients with acute deep venous thrombosis and active malignancy compared with weight adjusted subcutaneous LMWH. Methods Of 138 randomized patients, 100 patients with active malignancy presenting with acute deep venous thrombosis and still treated with chemotherapy were assigned to either oral apixaban therapy or subcutaneous low-molecular weight heparin (enoxaparin) through randomized clinical study in 1:1 ratio. All patients were followed up to six months. The primary end point was major bleeding, while secondary end points were recurrent deep venous thrombosis or venous thromboembolism, minor or non-fatal bleeding and mortality related to massive pulmonary embolism. Results Both groups were matched regarding their baseline demographic, clinical and laboratory characteristics. We had 84 patients with metastatic cancer (stage 4). The most prevalent type of malignancy was cancer colon (42% of cases). There was no significant difference between both groups regarding the incidence of primary and secondary end points. There were no reported mortality cases related to massive pulmonary embolism in both groups. Conclusion In this limited study, there was no difference in the major bleeding, recurrent deep venous thrombosis or minor bleeding in patients with active malignancy when treated with either apixaban or LMWH. Trial registration: ClinicalTrials.gov (NCT04462003). Registered 7 July 2020 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04462003

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Venous Thromboembolism

10.2310/7900.1102 ◽

2020 ◽

Author(s):

Samuel Z. Goldhaber

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Antithrombotic Agents ◽

Vein Thrombosis ◽

Recurrent Venous Thrombosis ◽

Deep Vein ◽

D Dimer ◽

In Pregnancy

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P14.33 Preoperative Lactate Dehydrogenase levels as a predictor of venous thromboembolism development in glioblastoma patients

Neuro-Oncology ◽

10.1093/neuonc/noab180.154 ◽

2021 ◽

Vol 23 (Supplement_2) ◽

pp. ii45-ii45

Author(s):

A Jacquerie ◽

S Huijs ◽

V M P Moers-Hornikx ◽

A M H G van der Heijden-Montfroy ◽

M P J van Goor ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Lactate Dehydrogenase ◽

Sinus Thrombosis ◽

Receiver Operating Curve ◽

Bleeding Complications ◽

Karnofsky Performance Score ◽

Vein Thrombosis ◽

Deep Vein

Abstract BACKGROUND Venous thromboembolism (VTE) is a common complication in patients with glioblastoma. Despite high incidence of up to 30% per year, concerns about bleeding complications have limited the use of primary anticoagulant prophylaxis. Finding a suitable biomarker to assess the risk of occurrence is therefore of utmost clinical interest. We performed an exploratory study of preoperative routinely used haematological markers as predictor for the development of VTE in glioblastoma patients. MATERIAL AND METHODS Data was retrospectively collected from an existing database of 307 patients diagnosed with glioblastoma by the Oncology Network South-East Netherlands (OnzoZON) between 2006 and 2020. Collected preoperative haematological markers included: haemoglobin, platelets, lactate dehydrogenase, neutrophils, lymphocytes, albumin and derived ratios. In addition, type and date of VTE were retrieved from medical records. Receiver operating curve was used to identify the optimal cut-off values of the preoperative haematological markers. Univariate and multivariate logistic regression analyses were performed to predict VTE for each haematologic marker independently. Variables included in the multivariate analyses were age, gender, type of surgery, Karnofsky performance score, MGMT status, weight, height and BMI, already available from the primary database. RESULTS In the total dataset, 45 patients (15%) suffered from a VTE, most common pulmonary embolism (51%) followed by deep vein thrombosis (31%). Mean time from diagnosis until VTE was 4.3 months (SD = 5.5). Preoperative haemoglobin value was available for analyses in 265 patients, platelets value in 226, lactate dehydrogenase in 98, neutrophils in 133, lymphocytes in 133 and albumin in 56 patients. A preoperative lactate dehydrogenase value > 243 U/L was found to increase the risk of VTE in both univariate and multivariate analysis (P <0.05). Seventeen out of 98 patients of whom lactate dehydrogenase level was available suffered from a VTE, most common pulmonary embolism (59%), followed by deep vein thrombosis (29%) and cerebral venous sinus thrombosis (12%). An elevated lactate dehydrogenase in serum increased the odds for getting a VTE by 3.2 (1.1–9.4). None of the other investigated haematological markers or ratios were found to be significantly correlated with the occurrence of VTE in our study. CONCLUSION Glioblastoma initiates locally haemostatic abnormalities, that propagate systemically though circulating mediators. Our exploratory analysis shows for the first time that preoperative lactate dehydrogenase levels might aid clinicians in identifying patients at risk for a venous thromboembolism. Ultimately this could lead to preventive measures and patient education, but larger and prospective validation of these findings is warranted.

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