Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels. Issue 192 (August 2020)

• Record Type: Journal Article
• Authors: Demelo-Rodríguez, P.; Cervilla-Muñoz, E.; Ordieres-Ortega, L.; Parra-Virto, A.; Toledano-Macías, M.; Toledo-Samaniego, N.; García-García, A.; García-Fernández-Bravo, I.; Ji, Z.; de-Miguel-Diez, J.; Álvarez-Sala-Walther, L.A.; del-Toro-Cervera, J.; Galeano-Valle, F.
• Is Part Of: Thrombosis research. Issue 192(2020)
• Page Start: 23
• Page End: 26
• Publication Date: 2020-08
• Subjects: COVID-19 -- SARS-CoV-2 infection -- Venous thromboembolism -- Deep vein thrombosis -- D-dimer -- Doppler ultrasound; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2020.05.018
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Aim: An increased risk of venous thromboembolism (VTE) in patients with COVID-19 pneumonia admitted to intensive care unit (ICU) has been reported. Whether COVID-19 increases the risk of VTE in non-ICU wards remains unknown. We aimed to evaluate the burden of asymptomatic deep vein thrombosis (DVT) in COVID-19 patients with elevated D-dimer levels. Method: In this prospective study consecutive patients hospitalized in non-intensive care units with diagnosis of COVID-19 pneumonia and D-dimer > 1000 ng/ml were screened for asymptomatic DVT with complete compression doppler ultrasound (CCUS). The study was approved by the Institutional Ethics Committee. Results: The study comprised 156 patients (65.4% male). All but three patients received standard doses of thromboprophylaxis. Median days of hospitalization until CCUS was 9 (IQR 5–17). CCUS was positive for DVT in 23 patients (14.7%), of whom only one was proximal DVT. Seven patients (4.5%) had bilateral distal DVT. Patients with DVT had higher median D-dimer levels: 4527 (IQR 1925-9144) ng/ml vs 2050 (IQR 1428-3235) ng/ml; p < 0.001. D-dimer levels > 1570 ng/ml were associated with asymptomatic DVT (OR 9.1; CI 95% 1.1–70.1). D-dimer showed an acceptable discriminative capacity (area under the ROC curve 0.72, 95% CI 0.61–0.84). Conclusion: In patients admitted with COVID-19 pneumonia and elevated D-dimer levels, the incidence of asymptomatic DVT is similar to that described in other series. Higher cut-off levels for D-dimer might be necessary for the diagnosis of DVT in COVID-19 patients. Highlights: An increased risk of VTE in patients with COVID-19 pneumonia admitted to intensive care unit has been reported. The most consistent hemostatic abnormalities with COVID-19 include mild thrombocytopenia and increased D-dimer levels. In COVID-19 patients with high D-dimer levels, the incidence of asymptomatic DVT is similar to that described in other series. Higher cut-off levels for D-dimer might be necessary for the diagnosis of DVT in COVID-19 patients.