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Systematic assessment of venous thromboembolism in COVID-19 patients receiving thromboprophylaxis: incidence and role of D-dimer as predictive factors.
J Thromb Thrombolysis. 2020 Jul; 50(1):211-216.JT

Abstract

Coagulopathy in COVID-19 is a burning issue and strategies to prevent thromboembolic events are debated and highly heterogeneous. The objective was to determine incidence and risk factors of venous thromboembolism (VTE) in COVID-19 inpatients receiving thromboprophylaxis. In this retrospective French cohort study, patients hospitalized in medical wards non-ICU with confirmed COVID-19 and adequate thromboprophylaxis were included. A systematic low limb venous duplex ultrasonography was performed at hospital discharge or earlier if deep venous thrombosis (DVT) was clinically suspected. Chest angio-CT scan was performed when pulmonary embolism (PE) was suspected. Of 71 patients, 16 developed VTE (22.5%) and 7 PE (10%) despite adequate thromboprophylaxis. D-dimers at baseline were significantly higher in patients with DVT (p < 0.001). Demographics, comorbidities, disease manifestations, severity score, and other biological parameters, including inflammatory markers, were similar in patients with and without VTE. The negative predictive value of a baseline D-dimer level < 1.0 µg/ml was 90% for VTE and 98% for PE. The positive predictive value for VTE was 44% and 67% for D-dimer level ≥ 1.0 µg/ml and ≥ 3 µg/ml, respectively. The association between D-dimer level and VTE risk increased by taking into account the latest available D-dimer level prior to venous duplex ultrasonography for the patients with monitoring of D-dimer. Despite thromboprophylaxis, the risk of VTE is high in COVID-19 non-ICU inpatients. Increased D-dimer concentrations of more than 1.0 μg/ml predict the risk of venous thromboembolism. D-dimer level-guided aggressive thromboprophylaxis regimens using higher doses of heparin should be evaluated in prospective studies.

Authors+Show Affiliations

Service de Médecine Interne, CHU de Nantes, 44093, Nantes, France.Service de Médecine Interne, CHU de Nantes, 44093, Nantes, France.Service de Médecine Interne, CHU de Nantes, 44093, Nantes, France.Service de Médecine Polyvalente, CH de Châteaubriant, 44110, Châteaubriant, France.Service de Maladies Infectieuses et Tropicales, CHU de Nantes, 44093, Nantes, France. CIC UIC 1413 INSERM, CHU de Nantes, 44093, Nantes, France.Service de Maladies Infectieuses et Tropicales, CHU de Nantes, 44093, Nantes, France. CIC UIC 1413 INSERM, CHU de Nantes, 44093, Nantes, France.Service de Médecine Interne, CHU de Nantes, 44093, Nantes, France. Faculté de Médecine, Université de Nantes, 44093, Nantes, France.Service de Maladies Infectieuses et Tropicales, CHU de Nantes, 44093, Nantes, France. raphael.lecomte@chu-nantes.fr. CIC UIC 1413 INSERM, CHU de Nantes, 44093, Nantes, France. raphael.lecomte@chu-nantes.fr.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

32451823

Citation

Artifoni, Mathieu, et al. "Systematic Assessment of Venous Thromboembolism in COVID-19 Patients Receiving Thromboprophylaxis: Incidence and Role of D-dimer as Predictive Factors." Journal of Thrombosis and Thrombolysis, vol. 50, no. 1, 2020, pp. 211-216.
Artifoni M, Danic G, Gautier G, et al. Systematic assessment of venous thromboembolism in COVID-19 patients receiving thromboprophylaxis: incidence and role of D-dimer as predictive factors. J Thromb Thrombolysis. 2020;50(1):211-216.
Artifoni, M., Danic, G., Gautier, G., Gicquel, P., Boutoille, D., Raffi, F., Néel, A., & Lecomte, R. (2020). Systematic assessment of venous thromboembolism in COVID-19 patients receiving thromboprophylaxis: incidence and role of D-dimer as predictive factors. Journal of Thrombosis and Thrombolysis, 50(1), 211-216. https://doi.org/10.1007/s11239-020-02146-z
Artifoni M, et al. Systematic Assessment of Venous Thromboembolism in COVID-19 Patients Receiving Thromboprophylaxis: Incidence and Role of D-dimer as Predictive Factors. J Thromb Thrombolysis. 2020;50(1):211-216. PubMed PMID: 32451823.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systematic assessment of venous thromboembolism in COVID-19 patients receiving thromboprophylaxis: incidence and role of D-dimer as predictive factors. AU - Artifoni,Mathieu, AU - Danic,Gwenvael, AU - Gautier,Giovanni, AU - Gicquel,Pascal, AU - Boutoille,David, AU - Raffi,François, AU - Néel,Antoine, AU - Lecomte,Raphaël, PY - 2020/5/27/pubmed PY - 2020/6/20/medline PY - 2020/5/27/entrez KW - COVID-19 KW - D-dimer KW - Pulmonary embolism KW - Venous thromboembolism SP - 211 EP - 216 JF - Journal of thrombosis and thrombolysis JO - J. Thromb. Thrombolysis VL - 50 IS - 1 N2 - Coagulopathy in COVID-19 is a burning issue and strategies to prevent thromboembolic events are debated and highly heterogeneous. The objective was to determine incidence and risk factors of venous thromboembolism (VTE) in COVID-19 inpatients receiving thromboprophylaxis. In this retrospective French cohort study, patients hospitalized in medical wards non-ICU with confirmed COVID-19 and adequate thromboprophylaxis were included. A systematic low limb venous duplex ultrasonography was performed at hospital discharge or earlier if deep venous thrombosis (DVT) was clinically suspected. Chest angio-CT scan was performed when pulmonary embolism (PE) was suspected. Of 71 patients, 16 developed VTE (22.5%) and 7 PE (10%) despite adequate thromboprophylaxis. D-dimers at baseline were significantly higher in patients with DVT (p < 0.001). Demographics, comorbidities, disease manifestations, severity score, and other biological parameters, including inflammatory markers, were similar in patients with and without VTE. The negative predictive value of a baseline D-dimer level < 1.0 µg/ml was 90% for VTE and 98% for PE. The positive predictive value for VTE was 44% and 67% for D-dimer level ≥ 1.0 µg/ml and ≥ 3 µg/ml, respectively. The association between D-dimer level and VTE risk increased by taking into account the latest available D-dimer level prior to venous duplex ultrasonography for the patients with monitoring of D-dimer. Despite thromboprophylaxis, the risk of VTE is high in COVID-19 non-ICU inpatients. Increased D-dimer concentrations of more than 1.0 μg/ml predict the risk of venous thromboembolism. D-dimer level-guided aggressive thromboprophylaxis regimens using higher doses of heparin should be evaluated in prospective studies. SN - 1573-742X UR - https://www.unboundmedicine.com/medline/citation/32451823/Systematic_assessment_of_venous_thromboembolism_in_COVID_19_patients_receiving_thromboprophylaxis:_incidence_and_role_of_D_dimer_as_predictive_factors_ L2 - https://doi.org/10.1007/s11239-020-02146-z DB - PRIME DP - Unbound Medicine ER -