Coagulation parameters and venous thromboembolism in patients with and without COVID-19 admitted to the Emergency Department for acute respiratory insufficiency. Issue 196 (December 2020)

• Record Type: Journal Article
• Authors: Pizzi, Roberto; Gini, Giancarlo; Caiano, Lucia; Castelli, Beniamino; Dotan, Noga; Magni, Federica; Virano, Alexandra; Roveda, Andrea; Bertù, Lorenza; Ageno, Walter
• Is Part Of: Thrombosis research. Issue 196(2020)
• Page Start: 209
• Page End: 212
• Publication Date: 2020-12
• Subjects: Venous thromboembolism -- COVID-19 -- Coagulation -- D-dimer; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2020.09.004
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Background: In the recent outbreak of COVID-19 pandemic, increased D-dimer levels and high rates of venous thromboembolic events were reported. We aimed to compare coagulation parameters on admission between COVID-19 patients and non-COVID-19 patients with acute respiratory insufficiency and to describe VTE diagnosed at entry. Methods: In this single-centre, observational retrospective study consecutive patients admitted for fever and acute respiratory failure were included. Patients underwent laboratory tests, arterial blood gas, chest X-ray, point of care ultrasound (POCUS), limited compression ultrasonography of the lower limbs (L-CUS), chest CT-scan if necessary, and swab test for COVID-19. Results: Of 324 patients, 50% had COVID-19. COVID19 patients had significantly lower mean white blood cells, neutrophils, platelet count, and pCT values, and significantly higher CRP, LDH, and ferritin levels than non-COVID19 patients. D-dimer was increased in 86.5% COVID19 patients and in 84.9% non-COVID19 patients; mean values were similar (2185 ng/mL and 2814 ng/mL, respectively, p = n.s.). After multivariate analysis, results were unchanged (Odds Ratio 1.00 95%CI: 0.99–1.00, p = 0.21). PT and aPTT values were also similar between the two groups, fibrinogen levels were higher in COVID19 than in non-COVID19 patients (684 and 496 mg/dL, respectively, p < 0.0001). Five patients had asymptomatic proximal deep vein thrombosis detected by L-CUS (3 COVID19) and 2 patients had symptomatic pulmonary embolism (both non-COVID19). Conclusions: D-dimer levels were similarly increased in patients with and without SARS-CoV 2 related disease. There were few cases of asymptomatic deep vein thrombosis or symptomatic pulmonary embolism at first day of admission, similarly distributed between COVID19 patients and non-COVID19 patients. Highlights: High D-dimer levels are associated with an increased risk of venous thromboembolism in COVID-19 patients High D-dimer levels can be detected in most patients with acute respiratory failure, not only associated with SARS-CoV 2 The prevalence of deep venous thrombosis on admission was similar between patients with and without COVID-19 Patients with COVID-19 had significantly higher levels of CRP, LDH and ferritin than patients without COVID-19