Clinical characteristics of acute lower extremity deep venous thrombosis diagnosed by duplex in patients hospitalized for coronavirus disease 2019

Koleilat, Issam; Galen, Benjamin T.; Choinski, Krystina; Hatch, Ayesha Nzeribe; Jones, Davis; Billett, Henny H.; Indes, Jeff; Lipsitz, Evan C.

doi:10.1016/j.jvsv.2020.06.012

Cited by 48 publications

(71 citation statements)

References 23 publications

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“…A total of 777 records were collected by the databases and manual searching. After the exclusion of the duplicates, review articles, case reports, pre‐printed versions without peer‐review, and irrelevant studies by title or abstract screening, 187 studies remained for full‐text review; 52 studies 6,17‐67 were finally included into the meta‐analysis, and 18 studies were included in the qualitative synthesis (Figure 1). A total of 52 records involving 10 614 COVID‐19 patients confirmed between December 25, 2019, and June 1, 2020, were included.…”

Section: Resultsmentioning

confidence: 99%

Ferritin in the coronavirus disease 2019 (COVID‐19): A systematic review and meta‐analysis

Cheng

et al. 2020

Clinical Laboratory Analysis

319

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Objective The coronavirus disease 2019 (COVID‐19) has rapidly developed into a pandemic. Increased levels of ferritin due to cytokine storm and secondary hemophagocytic lymphohistiocytosis were found in severe COVID‐19 patients. Therefore, the aim of this study was to determine the role of ferritin in COVID‐19. Methods Studies investigating ferritin in COVID‐19 were collected from PubMed, EMBASE, CNKI, SinoMed, and WANFANG. A meta‐analysis was performed to compare the ferritin level between different patient groups: non‐survivors versus survivors; more severe versus less severe; with comorbidity versus without comorbidity; ICU versus non‐ICU; with mechanical ventilation versus without mechanical ventilation. Results A total of 52 records involving 10 614 COVID‐19‐confirmed patients between December 25, 2019, and June 1, 2020, were included in this meta‐analysis, and 18 studies were included in the qualitative synthesis. The ferritin level was significantly increased in severe patients compared with the level in non‐severe patients [WMD 397.77 (95% CI 306.51‐489.02), P < .001]. Non‐survivors had a significantly higher ferritin level compared with the one in survivors [WMD 677.17 (95% CI 391.01‐963.33), P < .001]. Patients with one or more comorbidities including diabetes, thrombotic complication, and cancer had significantly higher levels of ferritin than those without (P < .01). Severe acute liver injury was significantly associated with high levels of ferritin, and its level was associated with intensive supportive care, including ICU transfer and mechanical ventilation. Conclusions Ferritin was associated with poor prognosis and could predict the worsening of COVID‐19 patients.

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Section: Resultsmentioning

confidence: 99%

Ferritin in the coronavirus disease 2019 (COVID‐19): A systematic review and meta‐analysis

Cheng

et al. 2020

Clinical Laboratory Analysis

319

251

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“…Of the 35 observational studies included, four were prospective 9 29 30 31 and the remaining 30 were cross-sectional and retrospective studies. 7 11 30 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 All studies enrolled hospitalized patients with confirmed diagnosis of COVID-19; 11 focused on intensive care unit (ICU) population. 7 29 30 38 40 42 48 50 51 52 53 The total numbers of studies reporting the incidence of VTE or bleeding in patients receiving no prophylaxis, standard-dose prophylaxis, intermediate-dose prophylaxis, and therapeutic-dose anticoagulants were 7, 32, 8, and 13, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…The pooled incidence of total VTE according to the pharmacologic thromboprophylaxis received were as follows: no prophylaxis 41 . Pair-wise comparison revealed a significant difference between no prophylaxis versus standard-dose prophylaxis (p ¼ 0.007), no prophylaxis versus intermediate-dose prophylaxis (p ¼ 0.009), and no prophylaxis versus therapeutic-dose anticoagulants (p ¼ 0.002).…”

Section: Pharmacologic Thromboprophylaxis Strategies and Incidence Ofmentioning

confidence: 99%

Pharmacologic Thromboprophylaxis and Thrombosis in Hospitalized Patients with COVID-19: A Pooled Analysis

et al. 2020

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Background Coronavirus disease 2019 (COVID-19) increases thrombosis in hospitalized patients prompting adoption of different thromboprophylaxis strategies. Safety and efficacy of escalated-dose pharmacologic thromboprophylaxis are not established. Objectives To determine the pooled incidence of thrombosis/bleeding in hospitalized patients with COVID-19 for standard-dose, intermediate-dose, therapeutic anticoagulation, and no pharmacologic thromboprophylaxis. Methods MEDLINE, EMBASE, and Cochrane CENTRAL were searched up to August 29, 2020 for studies reporting pharmacologic thromboprophylaxis and thrombosis or bleeding. Pooled event rates were calculated using a random-effects model. Results Thirty-five observational studies were included. The pooled incidence rates of total venous thromboembolism (N = 4,685) were: no prophylaxis 41.9% (95% confidence interval [CI]: 28.1–57.2, I 2 = 76%), standard-dose prophylaxis 19.8% (95% CI: 13.2–28.6, I 2 = 95%), intermediate-dose prophylaxis 11.9% (95% CI: 4.3–28.6, I 2 = 91%), and therapeutic-dose anticoagulants 10.5% (95% CI: 4.2–23.8, I 2 = 82%, p = 0.003). The pooled incidence rates of arterial thrombosis (N = 1,464) were: no prophylaxis 11.3% (95% CI: 5.2–23.0, I 2 = 0%), standard-dose prophylaxis 2.5% (95% CI: 1.4–4.3, I 2 = 45%), intermediate-dose prophylaxis 2.1% (95% CI: 0.5–7.7, I 2 = 45%), and therapeutic-dose anticoagulants 1.3% (95% CI: 0.2–8.8, I 2 = 0, p = 0.009). The pooled bleeding event rates (N = 6,393) were nonsignificantly higher in therapeutic-dose anticoagulants compared with standard-dose prophylaxis, (6.3 vs. 1.7%, p = 0.083). Conclusion Thrombosis rates were lower in hospitalized COVID-19 patients who received pharmacologic thromboprophylaxis. Thrombosis and bleeding rates for patients receiving intermediate-dose thromboprophylaxis or therapeutic anticoagulation were similar to those who received standard-dose pharmacologic thromboprophylaxis.

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“…6,9 Multiple reports of venous thromboembolism (VTE), arterial thrombosis, acute stroke, clotting of vascular access catheters and dialysis circuits have been described in Covid-19 patients. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Per published reports, the cumulative incidence of VTE (deep venous thrombosis and pulmonary embolism) in Covid-19 patients varies from 7.7% up to 69%. [10][11][12][16][17][18][19][20][21][22][23][24][25][26][27] The pathophysiology of CAC includes 2 mechanisms: systemic inflammation or cytokine storm causing endothelial cell activation and injury in the lung micro vasculature leading to pulmonary micro thrombosis and a hypercoagulable state leading to large vessel thrombosis.…”

Section: Introductionmentioning

confidence: 99%

“… 29 The true prevalence of thromboembolic complications in ICU patients with Covid-19 is difficult to estimate, as it may not be feasible to transport critically ill patients and there is a risk of nosocomial spread of the virus among healthcare staff and hospitalized patients, thereby limiting diagnostic imaging studies. 14 It is also unclear if patients with Covid-19 associated coagulopathy are prone to develop thrombotic events with time and if thrombotic events are associated with higher mortality. The primary aim of our study was to prospectively investigate the cumulative incidence of thromboembolic events in hospitalized Covid-19 patients needing ICU admission and assessing the utility of point of care ultrasound (POCUS) to screen and diagnose lower extremity deep venous thrombosis (DVT).…”

Section: Introductionmentioning

confidence: 99%

Thromboembolic Events and Role of Point of Care Ultrasound in Hospitalized Covid-19 Patients Needing Intensive Care Unit Admission

Kapoor

Chand

Dieiev

et al. 2020

J Intensive Care Med

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Background: Covid-19 associated coagulopathy (CAC) is associated with prothrombotic state and thromboembolism. However, true incidence of thromboembolic events is difficult to determine in the ICU setting. The aim of our study was to investigate the cumulative incidence of thromboembolic events in Covid-19 patients needing intensive care unit (ICU) admission and assessing the utility of point of care ultrasound (POCUS) to screen for and diagnose lower extremity deep venous thrombosis (DVT). Methods: We conducted a prospective observational study between April 22nd and May 26th, 2020 where all adult patients with the diagnosis of Covid-19 pneumonia admitted to 8 ICUs of Montefiore Medical Center were included. POCUS exam was performed on all patients at day 1 of ICU admission and at day 7 and 14 after the first exam. Results: The primary outcome was to study the cumulative incidence of thromboembolic events in Covid-19 patients needing ICU admission. A total of 107 patients were included. All patients got POCUS exam on day 1 in the ICU, 62% got day 7 and 41% got day 14 exam. POCUS diagnosed 17 lower extremity DVTs on day 1, 3 new on day 7 and 1 new on day 14. Forty patients developed 52 thromboembolic events, with the rate of 37.3%. We found a high 45-day cumulative incidence of thromboembolic events of 37% and a high 45-day cumulative incidence of lower and upper extremity DVT of 21% and 10% respectively. Twelve (30%) patients had failure of therapeutic anticoagulation. Occurrence of a thromboembolic event was not associated with a higher risk of mortality (HR 1.08, p value = .81). Conclusions: Covid-19 patients in ICU have a high cumulative incidence of thromboembolic events, but not associated with higher mortality. POCUS is an excellent tool to help screen and diagnose DVT during a pandemic.

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Clinical characteristics of acute lower extremity deep venous thrombosis diagnosed by duplex in patients hospitalized for coronavirus disease 2019

Cited by 48 publications

References 23 publications

Ferritin in the coronavirus disease 2019 (COVID‐19): A systematic review and meta‐analysis

Ferritin in the coronavirus disease 2019 (COVID‐19): A systematic review and meta‐analysis

Pharmacologic Thromboprophylaxis and Thrombosis in Hospitalized Patients with COVID-19: A Pooled Analysis

Thromboembolic Events and Role of Point of Care Ultrasound in Hospitalized Covid-19 Patients Needing Intensive Care Unit Admission

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