scholarly journals Venous Doppler Ultrasound in Critically Ill Covid-19 Patients: Game Changer in Anticoagulation Therapy

2020 ◽  
Author(s):  
Marta Alfageme ◽  
Jorge González Plaza ◽  
María Luisa Collado ◽  
Santiago Méndez ◽  
Juan A. Gómez Patiño ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Respiratory Failure ◽  
Critically Ill ◽  
Doppler Ultrasound ◽  
Acute Pulmonary Embolism ◽  
Anticoagulation Therapy ◽  
Lower Limbs ◽  
Severe Respiratory Failure ◽  
Asymptomatic Patients ◽  
D Dimer

Abstract BackgroundCOVID-19 infection has been associated with a high rate of thrombotic events, such as deep vein thrombosis (DVT) and acute pulmonary embolism (APE).MethodsThe purpose of our retrospective study was to evaluate the prevalence of asymptomatic DVT in lower limbs in critically ill COVID-19 patients (n=23) with severe respiratory failure and high levels of D-dimer by bedside Doppler ultrasound (DU).ResultsDVT was diagnosed in 14 cases (60.87%), 5 in proximal venous territory and 9 in infrapopliteal veins. CTPA was performed in 6 patients and all of them showed acute pulmonary embolism (APE) at segmental or subsegmental branches of pulmonary arteries. These patients (APE or DVT confirmed) were treated with therapeutic doses of anticoagulant therapy.ConclusionIn critically COVID 19 ill ICU patients with severe respiratory failure y elevated D-dimer the incidence of asymptomatic DVT is high. We propose that DU allows detection of DVT in asymptomatic patients, adding a factor that may balance the decision to fully anticoagulated these patients.

scholarly journals Venous Doppler ultrasound in critically Ill COVID-19 patients: game changer in anticoagulation therapy

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Marta Alfageme ◽  
Jorge González Plaza ◽  
Santiago Méndez ◽  
Juan A. Gómez Patiño ◽  
María L. Collado ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Respiratory Failure ◽  
Critically Ill ◽  
Doppler Ultrasound ◽  
Acute Pulmonary Embolism ◽  
Anticoagulation Therapy ◽  
Lower Limbs ◽  
Severe Respiratory Failure ◽  
Asymptomatic Patients ◽  
D Dimer

Abstract Background COVID-19 infection has been associated with a high rate of thrombotic events, such as deep vein thrombosis (DVT) and acute pulmonary embolism (APE). Methods The purpose of our retrospective study was to evaluate the prevalence of asymptomatic DVT in lower limbs in critically ill COVID-19 patients (n = 23) with severe respiratory failure and high levels of D-dimer by bedside Doppler ultrasound (DU). Results DVT was diagnosed in 14 cases (60.87%), 5 in proximal venous territory and 9 in infrapopliteal veins. Computed Tomography Pulmonary Angiography (CTPA) was performed in six patients and all of them showed acute pulmonary embolism (APE) at segmental or subsegmental branches of pulmonary arteries. These patients (APE or DVT confirmed) were treated with therapeutic doses of anticoagulant therapy. Conclusion In critically COVID-19 ill ICU patients with severe respiratory failure and elevated D-dimer, the incidence of asymptomatic DVT is high. We propose that DU allows detection of DVT in asymptomatic patients, adding a factor that may balance the decision to fully anticoagulate these patients.

scholarly journals Pulmonary embolism in patients with severe COVID-19 treated with intermediate- to full-dose enoxaparin

2020 ◽  
Author(s):  
Cleante Scarduelli ◽  
Francesco Inglese ◽  
Massimiliano Beccaria ◽  
Fabio Spreafico ◽  
Martina Garuti ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Respiratory Failure ◽  
Case Series ◽  
Pulmonary Angiography ◽  
Arterial Oxygen ◽  
Positive Pressure ◽  
Severe Respiratory Failure ◽  
Retrospective Case ◽  
Full Dose ◽  
D Dimer

Abstract Background: Coronavirus disease 2019 (COVID-19) may predispose patients to venous thromboembolism (VTE) due to inflammation, hypoxia, immobilization, and diffuse intravascular coagulation, despite standard thrombopropylaxis. Our retrospective study reports the incidence of pulmonary embolism (PE) in patients with COVID-19 and severe respiratory failure(SRF) treated with intermediate to full-dose enoxaparin. .Methods: This retrospective case series analysed data from patients with COVID-19 pneumonia and severe respiratory failure (SRF) admitted to our Respiratory Intensive Care Unit (RICU) between February 27 and April 20, 2020 for non-invasive positive-pressure ventilation. All patients received at least intermediate-dose enoxaparin (40 mg twice daily). If PE was suspected or diagnosed, patients were treated with full-dose enoxaparin (1 mg/kg twice daily). Computed tomography pulmonary angiography (CTPA) was used to detect PE in patients with elevated D-dimer levels (> 3000 ng/mL) and/or other clinical indicators, including sudden worsening of cardiopulmonary status.Results: Ninety-two patients (71 males, 21 females; mean age 58 ± 11 years) with COVID-19 pneumonia and SRF (mean arterial oxygen partial pressure/fractional inspired oxygen [PaO2/FiO2] of 143 ± 45 mm Hg) were admitted to our RICU. Twenty-two patients underwent CTPA (24%), with PEs detected in 11 (12%). Mean PaO2/FiO2 and mean D-dimer levels did not significantly differ between patients with or without PE. Eleven patients (12%) died in the hospital, with a mean age of 70 ± 11 years for deceased patients and 56 ± 11 years for surviving patients (p < 0.0001).Conclusions: PE was diagnosed in 12% of patients despite intermediate to full-dose enoxaparin treatment. However the incidence of PE in our patients was lower than that previously reported. We hypothesize that this reduced PE incidence may have been secondary to the higher than prophylactic enoxaparin dose that was used.

Diagnosis of Deep Vein Thrombosis (DVT) In Critically Ill Patients

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5123-5123
Author(s):  
Arino Yaguchi ◽  
Ryuichi Moroi ◽  
Tomoyuki Harada ◽  
Munekazu Takeda ◽  
Masaru Abe ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Conflicts Of Interest ◽  
Lower Limbs ◽  
Duplex Scanning ◽  
Icu Patients ◽  
Vital Status ◽  
Significant Difference ◽  
D Dimer

Abstract Abstract 5123 Introduction: The assessment of existences of DVT is important to prevent pulmonary embolism for hospitalized patients. Especially, there is a high incidence of DVT in critically ill patients in the intensive care unit (ICU). Because almost all the patients in the ICU have limitations of their activities of daily living due to unstable vital status, controlled under the analgesia, or multiple injuries. The aim of the present study is to evaluate D-dimer levels as a diagnostic marker of DVT in critically ill patients. Methods: One-hundred ten adult patients (66 men, 44 women; age range 20–94 [median 64.5]) who admitted in our medico-surgical ICU in a university hospital were enrolled in this study. Serum D-dimer test and ultrasonic duplex scanning (ALOKA, Co., Ltd, Tokyo) were performed within one week after admission to the ICU. Serum D-dimer levels (μ g/mL) were measured by latex agglutination test (Sekisui Medical®, Tokyo) (normal &lt;1.0μ g/mL). PT-INR (Quick one method) and APTT ratio (Langdell method) were also measured (Sysmex®, Kobe, Japan). DVT was diagnosed by ultrasonic duplex scanning. Value was expressed by median. Data were analyzed by Fisher's exact probability test and Mann-Whitney U test. A p &lt; .05 was considered as statistically significant. Results: There were 32 patients (29.0 %) with DVT and 78 without DVT (71%) in the ICU. Primary diagnoses on admission were 31 cerebrovascular disease, 30 trauma patients, 16 sepsis, 9 acute respiratory failure, 8 hemorrhagic shock, 8 cardiogenic failure and 8 others. Between patients with DVT and without DVT, there were no significant differences in age (67.5 vs. 64.0, p=0.71), sex (19 men and 13 women vs. 47 men and 31 women, p=0.93), primary diagnosis (p=0.13), PT-INR (1.06 vs. 1.07, p=0.97) or APTT ratio (1.02 vs. 1.04, p=0.81), respectively. D-dimer level was also no statistically significant difference (10.4 vs. 7.3μ g/mL, p=0.21) between patients with DVT and without DVT. D-dimer level was higher in all DVT patients with DVT and in 95 per cent of non-DVT patients than normal range. Moreover, thromobosis tended to exist in soleal vein and femoral vein (Table) Conclusion: The present study suggests that D-dimer level could not be a useful marker for assessment of existence of DVT in critically ill patients. And DVT almost existed in soleal and femoral veins. D-dimer level elevates because of the primary disease and/or complications of patients in the ICU. The ultrasonic duplex scanning is an easy and non-invasive examination at the bed side, while there is a limitation to perform it for ICU patients due to their unstable vital status, difficulty of appropriate posture, such as prone positioning, or injured lower limbs. But at least the examination by duplex scan of soleal and femoral veins, which have more possibility to develop to pulmonary embolism, could be significance in the ICU patients. Disclosures: No relevant conflicts of interest to declare.

Is there a link between lung parenchyma lesions , BMI , CRP , D-dimer and acute pulmonary embolism in patients infected with COVID-19 ?

2021 ◽  
Vol 21 ◽  
Author(s):  
Amer Hamadé ◽  
Lucas Jambert ◽  
Jonathan Tousch ◽  
Philippe Feuerstein ◽  
Karima Hammas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Lung Parenchyma ◽  
Lower Limbs ◽  
Nasopharyngeal Swab ◽  
Therapeutic Anticoagulation ◽  
Venous Thromboembolic Events ◽  
Acute Pe ◽  
D Dimer

Introduction: ince the outbreak of the COVID-19 pandemic , increasing suggests that infected patients present a high incidence of venous thromboembolic events (VTE). The main objective of this retrospective study was to evaluate the prevalence of acute pulmonary embolism (PE) on pulmonary computer tomography angiograms (CTPA) in patients classified as COVID-19 infection. The second objective was to determine if there is a link between D-dimer levels, serum C-reactive protein (CRP ), body mass index (BMI) , the lung parenchyma lesions (LPL) and acute pulmonary embolism (PE) in these patients. Material and Methods: 120 patients with mean age 65 ±14.5 years infected with COVID- 19 underwent in our institution a CTPA for suspected PE .Thirty four were in intensive care units (ICU). A COVID-19 diagnosis was made by transcriptase polymerase chain reaction by means of nasopharyngeal swab or by chest CT images. Demographics and co-morbidities characteristics were collected . Laboratory parameters were automatically extracted from our heath information system. When PE was suspected a CTPA were acquired after injection of high concentration iodine contrast media .The criterion of suspected PE were based on the clinical respiratory deterioration , with an increased need for oxygen. A venous duplex ultrasound (DU) test of lower limbs was performed on admission. Results: CTPA showed 24 acute PE (20%) , of which 11 primary and 13 associated with deep venous thrombosis diagnosed on DU .Eleven of the 24 (45.8 %)had PE despite preventive and therapeutic anticoagulation with low molecular weight heparin with Enoxaparin (7 with preventive anticoagulation and 4 had therapeutic dose), of them 8 (72.7%) with risk factors for VTE .Acute PE was not significantly associated with CRP and LPL. However , we found a significant association between acute PE and BMI (mean 32.41±5.90 versus 27.1± 5.2 kg/m2, p 0.0007) or D-dimer Levels (mean 6040±5068 versus 3396.7±5361.5 ng/ml ,p <0.0001). Conclusions: Hospitalized patients infected with COVID-19 in conventional units or ICU have a high frequency of PE justifying preventive anticoagulation. For those who have a risk factors for VTE a therapeutic anticoagulation may be indicated.

Tissue plasminogen activator as a novel diagnostic aid in acute pulmonary embolism

VASA ◽  
2014 ◽  
Vol 43 (6) ◽  
pp. 450-458 ◽  
Author(s):  
Julio Flores ◽  
Ángel García-Avello ◽  
Esther Alonso ◽  
Antonio Ruíz ◽  
Olga Navarrete ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Negative Predictive Value ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Enzyme Linked Immunosorbent Assay ◽  
Diagnostic Utility ◽  
Tissue Plasminogen ◽  
D Dimer

Background: We evaluated the diagnostic efficacy of tissue plasminogen activator (tPA), using an enzyme-linked immunosorbent assay (ELISA) and compared it with an ELISA D-dimer (VIDAS D-dimer) in acute pulmonary embolism (PE). Patients and methods: We studied 127 consecutive outpatients with clinically suspected PE. The diagnosis of PE was based on a clinical probability pretest for PE and a strict protocol of imaging studies. A plasma sample to measure the levels of tPA and D-dimer was obtained at enrollment. Diagnostic accuracy for tPA and D-dimer was determined by the area under the receiver operating characteristic (ROC) curve. Sensitivity, specificity, predictive values, and the diagnostic utility of tPA with a cutoff of 8.5 ng/mL and D-dimer with a cutoff of 500 ng/mL, were calculated for PE diagnosis. Results: PE was confirmed in 41 patients (32 %). Areas under ROC curves were 0.86 for D-dimer and 0.71 for tPA. The sensitivity/negative predictive value for D-dimer using a cutoff of 500 ng/mL, and tPA using a cutoff of 8.5 ng/mL, were 95 % (95 % CI, 88–100 %)/95 % (95 % CI, 88–100 %) and 95 % (95 % CI, 88–100 %)/94 %), respectively. The diagnostic utility to exclude PE was 28.3 % (95 % CI, 21–37 %) for D-dimer and 24.4 % (95 % CI, 17–33 %) for tPA. Conclusions: The tPA with a cutoff of 8.5 ng/mL has a high sensitivity and negative predictive value for exclusion of PE, similar to those observed for the VIDAS D-dimer with a cutoff of 500 ng/mL, although the diagnostic utility was slightly higher for the D-dimer.

Abstract 13317: Acute Pulmonary Embolism in Covid-19 Patients: Presenting Characteristics, Outcomes and Risk Stratification Strategies

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hai Xu ◽  
Angel Martin ◽  
Avneet SINGH ◽  
Mangala Narasimhan ◽  
Joe Lau ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Intensive Care ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Risk Stratification ◽  
Clinical Outcomes ◽  
Acute Pulmonary Embolism ◽  
Severe Bleeding ◽  
Study Cohort ◽  
D Dimer

Introduction: Pulmonary Embolism in coronavirus disease 2019 (COVID-19) patients have been increasingly reported in observational studies. However, limited knowledge describing their diagnostic features and clinical outcomes exist to date. Our study aims to systemically analyze their clinical characteristics and to investigate strategies for risk stratification. Methods: We retrospectively studied 101 patients with concurrent diagnoses of acute pulmonary embolism and COVID-19 infection, admitted at two tertiary hospitals within the Northwell Health System in New York City area. Clinical features including laboratory and imaging findings, therapeutic interventions, intensive care unit (ICU) admission, mortality and length of stay were recorded. D-dimer values were respectively documented at COVID-19 and PE diagnoses for comparison. Pulmonary Severity Index (PESI) scores were used for risk stratification of clinical outcomes. Results: The most common comorbidities were hypertension (50%), obesity (27%) and hyperlipidemia (32%) among our study cohort. Baseline D-dimer abnormalities (4647.0 ± 8281.8) were noted on admission with a 3-fold increase at the time of PE diagnosis (13288.4 ± 14917.9; p<0.05). 5 (5%) patients required systemic thrombolysis and 12 (12%) patients experienced moderate to severe bleeding. 31 (31%) patients developed acute kidney injury (AKI) and 1 (1%) patient required renal replacement therapy. Throughout hospitalization, 23 (23%) patients were admitted to intensive care units, of which 20 (20%) patients received invasive mechanical ventilation. The overall mortality rate was 20%. Majority of patients (65%) had Intermediate to high risk PESI scores (>85), which portended a worse prognosis with higher mortality rate and length of stay. Conclusions: This study provides characteristics and early outcomes for hospitalized patients with COVID-19 and acute pulmonary embolism. D-dimer levels and PESI scores may be utilized to risk stratify and guide management in this patient population. Our results should serve to alert the medical community to heighted vigilance of this VTE complication associated with COVID-19 infection, despite the preliminary and retrospective nature inherent to this study.

scholarly journals Wells’ Score in Diagnosis of Pulmonary Embolism in Patient with Thrombocytopenia: A Case Report

2019 ◽  
Vol 20 (3) ◽  
pp. 281-285
Author(s):  
Dragan Panic ◽  
Andreja Todorovic ◽  
Milica Stanojevic ◽  
Violeta Iric Cupic
Keyword(s):  
Pulmonary Embolism ◽  
Chest Pain ◽  
Acute Pulmonary Embolism ◽  
Pretest Probability ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Prediction Rules ◽  
Clinical Probability ◽  
Wells Score ◽  
D Dimer

Abstract Current diagnostic workup of patients with suspected acute pulmonary embolism (PE) usually starts with the assessment of clinical pretest probability, using clinical prediction rules and plasma D-dimer measurement. Although an accurate diagnosis of acute pulmonary embolism (PE) in patients is thus of crucial importance, the diagnostic management of suspected PE is still challenging. A 60-year-old man with chest pain and expectoration of blood was admitted to the Department of Cardiology, General Hospital in Cuprija, Serbia. After physical examination and laboratory analyses, the diagnosis of Right side pleuropne monia and acute pulmonary embolism was established. Clinically, patient was hemodynamically stable, auscultative slightly weaker respiratory sound right basal, without pretibial edema. Laboratory: C-reactive protein (CRP) 132.9 mg/L, Leukocytes (Le) 18.9x109/L, Erythrocytes (Er) 3.23x1012/L, Haemoglobin (Hgb) 113 g/L, Platelets (Plt) 79x109/L, D-dimer 35.2. On the third day after admission, D-dimer was increased and platelet count was decreased (Plt up to 62x109/L). According to Wells’ rules, score was 2.5 (without symptoms on admission), a normal clinical finding with clinical manifestation of hemoptysis and chest pain, which represents the intermediate level of clinical probability of PE. After the recidive of PE, Wells’ score was 6.5. In summary, this study suggests that Wells’ score, based on a patient’s risk for pulmonary embolism, is a valuable guidance for decision-making in combination with knowledge and experience of clinicians. Clinicians should use validated clinical prediction rules to estimate pretest probability in patients in whom acute PE is being consiered.

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