Applicability of bedside ultrasonography for the diagnosis of deep venous thrombosis in patients with COVID‐19 and treatment with low molecular weight heparin

Abstract

The aim of this study was to evaluate the applicability of bedside ultrasonography for the diagnosis of deep venous thrombosis (DVT) in patients infected with corona virus disease 2019 (COVID-19) with and without treatment with low molecular weight heparin (LMWH). Methods: We retrospectively analyzed the records of deceased and surviving patients in whom ultrasonography detected or not a DVT, and in whom LMWH was or not prescribed. Results: The incidence of DVT is higher in the deceased (33/35) than in the surviving (22/46) patients. LMWH was administered in a larger proportion of surviving (18/22) than of deceased (18/33) patients. D-dimer concentrations decreased in patients who received LMWH in both groups. Conclusions: There was a high incidence of DVT in patients who succumbed to COVID-19. Bedside ultrasonography can detect the presence of DVT as early as possible and help assessing the risk of venous thromboembolism, allowing early and reasonable use of LMWH. K E Y W O R D S bedside ultrasonography, COVID-19, deep venous thrombosis, low molecular weight heparin 1 | INTRODUCTION Corona virus disease 2019 (COVID-19), which was first reported in Wuhan, China, in late December 2019, is currently spreading to other provinces in mainland China and to other countries around the globe, with major public health and economic consequences. 1 Bedside ultrasonography can detect deep venous thrombosis (DVT) in a timely and accurate manner, which helps assessing the risk of venous thromboembolism. Bedside checks can be repeated in a short time span because there is no radiation, and can provide safe and important diagnostic information for patients with COVID-19. Based on existing studies, the clinical manifestations and pathological results of COVID-19 infection are associated with acute respiratory distress syndrome (ARDS), 2 characterized by respiratory distress and difficulty to correct hypoxemia, with a high mortality rate, 3 due to excessive intra-alveolar fibrin deposition. The imbalance between activation of coagulation and inhibition of fibrinolysis in patients with ARDS leads to fibrin formation, which occurs both systemically and in the lungs and airspace. 4 Nearly 20% of COVID-19 patients present severe coagulation abnormalities, which may occur in almost all of the severe and critical ill COVID-19 cases. 5 The large amount of thrombin can induce the expression of E-selectin, P-selectin, and platelet-activating factors, promote the aggregation and adhesion of platelets and activated neutrophils, and strengthen the interaction between endothelial cells and neutrophils, 6 Pu Zhang and Yali Qu contributed equally to this study.

Systematic review and meta-analysis of the prevalence of venous thromboembolic events in novel coronavirus disease-2019 patients

“…Systematic searches obtained a total of 2005 citations. After excluding duplicates and applying the inclusion/exclusion criteria, forty-one articles remained and met the inclusion criteria for quality appraisal after the full-text examination ( Figure 1 ) [ 4 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. In the quality assessment, thirty-one articles received a score of 8 out of 9, and nine studies received a score of 9 out of 9.…”

Prevalence of Venous Thromboembolism in Critically Ill COVID-19 Patients: Systematic Review and Meta-Analysis

“…Poissy et al (18) Ren et al (22) Stessel et al (20) Stessel et al (20) Thomas et al 21Zhang et al (30) , low risk; , high risk;…”

“…A recent study by Zhang et al evaluated the utility of bedside ultrasonography in the diagnosis of DVT. It revealed a significantly higher DVT prevalence in deceased patients than in surviving COVID-19 critically ill patients [94% (33/35) vs. 47% (22/46), P < 0.001] ( 30 ). Moreover, Wichmann et al analyzed autopsies of 12 COVID-19 patients.…”

Prevalence of Venous Thromboembolism in Critically-ill COVID-19 Patients: Systematic Review and Meta-analysis

“…It revealed a significantly higher DVT prevalence in deceased patients compared with surviving COVID-19 critically ill patients [94% (33/35) Vs. 47% (22/46), p < 0.001]. 33 Moreover, Wichmann et al analyzed autopsies of 12 COVID-19 patients. They found that seven (58%) had undiagnosed VTE, while in four (33.3%), massive PE was the direct cause of death.…”