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Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels.
Thromb Res. 2020 08; 192:23-26.TR

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.

Authors+Show Affiliations

Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain; Gregorio Marañón Sanitary Research Institute, Madrid, Spain.Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain.Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain.Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain.Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain.Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain.Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain.Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain.School of Medicine, Universidad Complutense de Madrid, Spain; Respiratory Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.School of Medicine, Universidad Complutense de Madrid, Spain; Gregorio Marañón Sanitary Research Institute, Madrid, Spain; Respiratory Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Respiratory Diseases CIBER (CIBERER), Madrid, Spain.School of Medicine, Universidad Complutense de Madrid, Spain; Gregorio Marañón Sanitary Research Institute, Madrid, Spain.Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain; Gregorio Marañón Sanitary Research Institute, Madrid, Spain.Venous Thromboembolism Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; School of Medicine, Universidad Complutense de Madrid, Spain; Gregorio Marañón Sanitary Research Institute, Madrid, Spain. Electronic address: paco.galeano.valle@gmail.com.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

32405101

Citation

Demelo-Rodríguez, P, et al. "Incidence of Asymptomatic Deep Vein Thrombosis in Patients With COVID-19 Pneumonia and Elevated D-dimer Levels." Thrombosis Research, vol. 192, 2020, pp. 23-26.
Demelo-Rodríguez P, Cervilla-Muñoz E, Ordieres-Ortega L, et al. Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels. Thromb Res. 2020;192:23-26.
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. (2020). Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels. Thrombosis Research, 192, 23-26. https://doi.org/10.1016/j.thromres.2020.05.018
Demelo-Rodríguez P, et al. Incidence of Asymptomatic Deep Vein Thrombosis in Patients With COVID-19 Pneumonia and Elevated D-dimer Levels. Thromb Res. 2020;192:23-26. PubMed PMID: 32405101.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels. AU - Demelo-Rodríguez,P, AU - Cervilla-Muñoz,E, AU - Ordieres-Ortega,L, AU - Parra-Virto,A, AU - Toledano-Macías,M, AU - Toledo-Samaniego,N, AU - García-García,A, AU - García-Fernández-Bravo,I, AU - Ji,Z, AU - de-Miguel-Diez,J, AU - Álvarez-Sala-Walther,L A, AU - Del-Toro-Cervera,J, AU - Galeano-Valle,F, Y1 - 2020/05/13/ PY - 2020/04/22/received PY - 2020/05/08/revised PY - 2020/05/12/accepted PY - 2020/5/15/pubmed PY - 2020/6/25/medline PY - 2020/5/15/entrez KW - COVID-19 KW - D-dimer KW - Deep vein thrombosis KW - Doppler ultrasound KW - SARS-CoV-2 infection KW - Venous thromboembolism SP - 23 EP - 26 JF - Thrombosis research JO - Thromb Res VL - 192 N2 - 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. SN - 1879-2472 UR - https://www.unboundmedicine.com/medline/citation/32405101/Incidence_of_asymptomatic_deep_vein_thrombosis_in_patients_with_COVID_19_pneumonia_and_elevated_D_dimer_levels_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-3848(20)30190-0 DB - PRIME DP - Unbound Medicine ER -