28.05.2020

Systematic assessment of venous thromboembolism in COVID-19 patients receiving thromboprophylaxis: incidence and role of D-dimer as predictive factors

Diagnostic Cardiology and metabolic diseasesHematology
Artifoni M et al
J Thrombosis Thrombolysis

Main result

71 patients were enrolled, including 61% of men (median age 34 years).
16 had venous thromboembolic disease (VTE) (22.5%) and 7 had pulmonary embolism (PE) (7%) despite prophylactic anti-thrombotic therapy.
D-dimers at admission were significantly higher in patients who subsequently developed deep vein thrombosis (p<0.001).
Demographics, comorbidities, symptoms, severity, and other laboratory parameters were similar in patients with and without VTE.
The negative predictive value of D-Dimers at admission (<1.0µg/mL) was 90% for VTE and 98% for PE.
The  D-dimers positive predictive value at admission for VTE was 44% at ≥1.0 µg/mL and 67% at ≥3 µg/mL.

Takeaways

Despite thromboprophylaxis, the risk of VTE is increased in patients with Covid-19 outside intensive care.
A D-dimer level greater than 1.0 ug/ml significantly predicts the risk of VTE.

Strength of evidence Weak

- Systematic screening of Deep Vein Thrombosis
- But retrospective study
- Multicenter (2), small size number (n=71)
- Selection bias on patients who did not have Doppler during hospitalization and who were excluded from the analyses

Objectives

To determine the incidence and risk factors associated with venous thromboembolic disease in patients with Covid-19 receiving thromboprophylaxis.

Method

Retrospective cohort study of patients hospitalized more than 48 hours outside intensive care for COVID-19 pneumonia and who benefited from thromboprophylaxis, in Nantes and Chateaubrian hospitals.
The diagnosis of SARS-CoV-2 infection was made by RT-PCR of nasopharyngeal sample or typical imaging on chest CT scan.

Thromboprophylaxis was considered adequate if it was put in place within 24 hours after admission and continued throughout the duration of hospitalization. It consisted of a daily injection of enoxaparin (BMI-dependent dosage).

Systematic Doppler of the lower limbs at the end of hospitalization or before if a deep venous thrombosis was suspected.

A chest scan was performed in case of suspected pulmonary embolism.

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