tetano
Editor, Senior Moderator
J Ultrasound Med
. 2020 Oct 5.
doi: 10.1002/jum.15524. Online ahead of print.
Incidence of Deep Venous Thrombosis in Patients With COVID-19 and Pulmonary Embolism: Compression Ultrasound COVID Study
Anabel Franco-Moreno[SUP] 1 [/SUP], Maria Herrera-Morueco[SUP] 1 [/SUP], Beatriz Mestre-G?mez[SUP] 1 [/SUP], Nuria Mu?oz-Rivas[SUP] 1 [/SUP], Ane Abad-Motos[SUP] 2 [/SUP], Danilo Salazar-Chiriboga[SUP] 3 [/SUP], Mercedes Duffort-Falc?[SUP] 1 [/SUP], Pilar Medrano-Izquierdo[SUP] 1 [/SUP], Ana Bustamante-Fermosel[SUP] 1 [/SUP], Virginia Pardo-Guimera[SUP] 1 [/SUP], Mariano Ulla-An?s[SUP] 1 [/SUP], Juan Torres-Macho[SUP] 1 [/SUP], Infanta Leonor Thrombosis Research Group
Affiliations
Abstract
Objectives: Several reports had observed a high risk of pulmonary embolism (PE) in patients with coronavirus disease 2019 (COVID-19), most of them in the intensive care unit. Reported findings indicate that a direct viral-mediated hyperinflammatory response leads to local thromboinflammation. According to those findings, the incidence of deep venous thrombosis (DVT) in patients with COVID-19 and PE should be low. The objective of this study was to evaluate the incidence of DVT in patients with COVID-19 who developed PE.
Methods: In this prospective observational study, consecutive patients hospitalized in the internal medicine ward with a diagnosis of COVID-19 who developed PE were screened for DVT in the lower extremities with complete compression ultrasound.
Results: The study comprised 26 patients. Fifteen patients (57.7%) were male. The median age was 60 years (interquartile range, 54-73 years). Compression ultrasound findings were positive for DVT in 2 patients (7.7%; 95% confidence interval, 3.6%-11.7%). Patients with DVT had central and bilateral PE. In both, venous thromboembolism was diagnosed in the emergency department, so they did not receive previous prophylactic therapy with low-molecular-weight heparin. Patients without DVT had higher median d-dimer levels: 25,688 μg/dL (interquartile range, 80,000-1210 μg/dL) versus 5310 μg/dL (P < .05).
Conclusions: Our study showed a low incidence of DVT in a cohort of patients with COVID-19 and PE. This observation suggests that PE in these patients could be produced mainly by a local thromboinflammatory syndrome induced by severe acute respiratory syndrome coronavirus 2 infection and not by a thromboembolic event.
Keywords: COVID-19; compression ultrasound; coronavirus disease 2019; deep venous thrombosis; pulmonary embolism; thromboinflammatory syndrome.
. 2020 Oct 5.
doi: 10.1002/jum.15524. Online ahead of print.
Incidence of Deep Venous Thrombosis in Patients With COVID-19 and Pulmonary Embolism: Compression Ultrasound COVID Study
Anabel Franco-Moreno[SUP] 1 [/SUP], Maria Herrera-Morueco[SUP] 1 [/SUP], Beatriz Mestre-G?mez[SUP] 1 [/SUP], Nuria Mu?oz-Rivas[SUP] 1 [/SUP], Ane Abad-Motos[SUP] 2 [/SUP], Danilo Salazar-Chiriboga[SUP] 3 [/SUP], Mercedes Duffort-Falc?[SUP] 1 [/SUP], Pilar Medrano-Izquierdo[SUP] 1 [/SUP], Ana Bustamante-Fermosel[SUP] 1 [/SUP], Virginia Pardo-Guimera[SUP] 1 [/SUP], Mariano Ulla-An?s[SUP] 1 [/SUP], Juan Torres-Macho[SUP] 1 [/SUP], Infanta Leonor Thrombosis Research Group
Affiliations
- PMID: 33017480
- DOI: 10.1002/jum.15524
Abstract
Objectives: Several reports had observed a high risk of pulmonary embolism (PE) in patients with coronavirus disease 2019 (COVID-19), most of them in the intensive care unit. Reported findings indicate that a direct viral-mediated hyperinflammatory response leads to local thromboinflammation. According to those findings, the incidence of deep venous thrombosis (DVT) in patients with COVID-19 and PE should be low. The objective of this study was to evaluate the incidence of DVT in patients with COVID-19 who developed PE.
Methods: In this prospective observational study, consecutive patients hospitalized in the internal medicine ward with a diagnosis of COVID-19 who developed PE were screened for DVT in the lower extremities with complete compression ultrasound.
Results: The study comprised 26 patients. Fifteen patients (57.7%) were male. The median age was 60 years (interquartile range, 54-73 years). Compression ultrasound findings were positive for DVT in 2 patients (7.7%; 95% confidence interval, 3.6%-11.7%). Patients with DVT had central and bilateral PE. In both, venous thromboembolism was diagnosed in the emergency department, so they did not receive previous prophylactic therapy with low-molecular-weight heparin. Patients without DVT had higher median d-dimer levels: 25,688 μg/dL (interquartile range, 80,000-1210 μg/dL) versus 5310 μg/dL (P < .05).
Conclusions: Our study showed a low incidence of DVT in a cohort of patients with COVID-19 and PE. This observation suggests that PE in these patients could be produced mainly by a local thromboinflammatory syndrome induced by severe acute respiratory syndrome coronavirus 2 infection and not by a thromboembolic event.
Keywords: COVID-19; compression ultrasound; coronavirus disease 2019; deep venous thrombosis; pulmonary embolism; thromboinflammatory syndrome.