COVID‐19 and Venous Thromboembolism in Intensive Care or Medical Ward

Avruscio, Giampiero; Camporese, Giuseppe; Campello, Elena; Bernardi, Enrico; Persona, Paolo; Passarella, Christian; Noventa, Franco; Cola, Marco; Navalesi, Paolo; Cattelan, Annamaria; Tiberio, Ivo; Boscolo, Annalisa; Spiezia, Luca; Simioni, Paolo

doi:10.1111/cts.12907

Cited by 52 publications

(64 citation statements)

References 38 publications

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“…18 A limitation of this study is that it included a relatively small number of patients from one medical center, which may have introduced ther study in future pediatric cohorts with larger sample size. 20,21 Peak values of the activated partial thromboplastin time (aPTT) were noted to be significantly elevated in this cohort, which is different from what has been reported in adult cohorts. However, the aPTT standard deviation was large due to four outlier values for which heparin contamination could not be ruled out.…”

Section: Discussioncontrasting

confidence: 98%

“…The use of D-dimer as a risk factor for thrombosis in COVID-19 was based on adult literature, as no pediatric data existed at that time. 20,21 The Ddimer cutoff of 10× our institutional ULN was based on both the observation that patients developing VTE generally had D-dimer > 5 µ/mL and the desire to limit use of higher doses of anticoagulation. Doses and monitoring were different for patients with obesity 13 or acute kidney injury.…”

Section: Discussionmentioning

confidence: 99%

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Children and young adults hospitalized for severe COVID‐19 exhibit thrombotic coagulopathy

Mitchell

Davila

Keenan

et al. 2021

Pediatric Blood & Cancer

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We report the clinical and laboratory coagulation characteristics of 27 pediatric and young adult patients (2 months to 21 years) treated for symptomatic COVID-19 at a children's hospital in the Bronx, New York, between March 1 and May 31, 2020. D-Dimer was > 0.5 µg/mL (upper limit of normal) in 25 (93%) patients at admission; 11 (41%) developed peak D-dimer > 5 µg/mL during admission. Seven (26%) patients developed venous thromboembolism: three with deep vein thrombosis and four with pulmonary embolism. Requirement of increased ventilatory support was a risk factor for thrombosis (P = 0.006). Three of eight (38%) patients on prophylactic anticoagulation developed thrombosis; however, no patients developed VTE on low-molecularweight heparin prophylaxis titrated to anti-Xa level. Manifestation of COVID-19 disease was severe or critical in 16 (59%) patients. Four (15%) patients died of COVID-19 complications: all had comorbidities. Elevated D-dimer and increased VTE rate were observed in this young cohort, particularly in those with severe respiratory complications, suggesting thrombotic coagulopathy. More data are needed to guide thromboprophylaxis in this age group.

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Section: Discussioncontrasting

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Children and young adults hospitalized for severe COVID‐19 exhibit thrombotic coagulopathy

Mitchell

Davila

Keenan

et al. 2021

Pediatric Blood & Cancer

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“…Though similar previous studies, this is the first one to report all blood tests performed in hospitalized COVID-19 patients by one-week periods, comparing groups with and without PE [23,24,34,35]. In a non-COVID-19 scenario, the negative predictive value of D-dimer testing is high, but the positive predictive value of elevated D-dimer levels is low.…”

Section: Discussionsupporting

confidence: 63%

“…for COVID-19 patients is recommended and should be the first step to prevent VTE [18,20]. However, since most of our PE patients were diagnosed between the week 2 and 4 after COVID-19 symptoms onset, it is important to have tools in clinical practice to identify patients at risk of developing PE despite thromboprophylaxis, mostly in ICU patients [35].…”

Section: Plos Onementioning

confidence: 99%

Blood test dynamics in hospitalized COVID-19 patients: Potential utility of D-dimer for pulmonary embolism diagnosis

et al. 2020

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Background A higher incidence of thrombotic events, mainly pulmonary embolism (PE), has been reported in hospitalized patients with COVID-19. The main objective was to assess clinical and laboratory differences in hospitalized COVID-19 patients according to occurrence of PE. Methods This retrospective study included all consecutive patients hospitalized with COVID-19 who underwent a computed tomography (CT) angiography for PE clinical suspicion. Clinical data and median blood test results distributed into weekly periods from COVID-19 symptoms onset, were compared between PE and non-PE patients. Results Ninety-two patients were included, 29 (32%) had PE. PE patients were younger (63.9 (SD 13.7) vs 69.9 (SD 12.5) years). Clinical symptoms and COVID-19 CT features were similar in both groups. PE was diagnosed after a mean of 20.0 (SD 8.6) days from the onset of COVID-19 symptoms. Corticosteroid boluses were more frequently used in PE patients (62% vs. 43%). No patients met ISTH DIC criteria. Any parameter was statistically significant or clinically relevant except for D-Dimer when comparing both groups. Median values [IQR] of D-dimer in PE vs non-PE patients were: week 2 (2010.7 [770.1–11208.9] vs 626.0 [374.0–2382.2]; p = 0.004); week 3 (3893.1 [1388.2–6694.0] vs 1184.4 [461.8–2447.8]; p = 0.003); and week 4 (2736.3 [1202.1–8514.1] vs 1129.1 [542.5–2834.6]; p = 0.01). Median fold-increase of D-dimer between week 1 and 2 differed between groups (6.64 [3.02–23.05] vs 1.57 [0.64–2.71], p = 0.003); ROC curve AUC was 0.879 (p = 0.003) with a sensitivity and specificity for PE of 86% and 80%, respectively. Conclusions Among hospitalized COVID-19 patients, D-dimer levels are higher at weeks 2, 3 and 4 after COVID-19 symptom onset in patients who develop PE. This difference is more pronounced when the fold increase between weeks 1 and 2 is compared.

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“…Earlier studies reported that a higher D-dimer concentration was associated with a higher risk for pulmonary thromboembolism for patients presented at the emergency department or admitted to the general ward [ 53 , 54 ]. However, adjustment for confounders was limited in these studies [ 53 , 54 ]. Oudkerk et al recommended using cut-off D-dimer values in consideration of applying CTPA in SARS-CoV-2 patients who are suspected of pulmonary thromboembolism [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Serial markers of coagulation and inflammation and the occurrence of clinical pulmonary thromboembolism in mechanically ventilated patients with SARS-CoV-2 infection; the prospective Maastricht intensive care COVID cohort

et al. 2021

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Background The incidence of pulmonary thromboembolism is high in SARS-CoV-2 patients admitted to the Intensive Care. Elevated biomarkers of coagulation (fibrinogen and D-dimer) and inflammation (c-reactive protein (CRP) and ferritin) are associated with poor outcome in SARS-CoV-2. Whether the time-course of fibrinogen, D-dimer, CRP and ferritin is associated with the occurrence of pulmonary thromboembolism in SARS-CoV-2 patients is unknown. We hypothesise that patients on mechanical ventilation with SARS-CoV-2 infection and clinical pulmonary thromboembolism have lower concentrations of fibrinogen and higher D-dimer, CRP, and ferritin concentrations over time compared to patients without a clinical pulmonary thromboembolism. Methods In a prospective study, fibrinogen, D-dimer, CRP and ferritin were measured daily. Clinical suspected pulmonary thromboembolism was either confirmed or excluded based on computed tomography pulmonary angiography (CTPA) or by transthoracic ultrasound (TTU) (i.e., right-sided cardiac thrombus). In addition, patients who received therapy with recombinant tissue plasminogen activator were included when clinical instability in suspected pulmonary thromboembolism did not allow CTPA. Serial data were analysed using a mixed-effects linear regression model, and models were adjusted for known risk factors (age, sex, APACHE-II score, body mass index), biomarkers of coagulation and inflammation, and anticoagulants. Results Thirty-one patients were considered to suffer from pulmonary thromboembolism ((positive CTPA (n = 27), TTU positive (n = 1), therapy with recombinant tissue plasminogen activator (n = 3)), and eight patients with negative CTPA were included. After adjustment for known risk factors and anticoagulants, patients with, compared to those without, clinical pulmonary thromboembolism had lower average fibrinogen concentration of − 0.9 g/L (95% CI: − 1.6 – − 0.1) and lower average ferritin concentration of − 1045 μg/L (95% CI: − 1983 – − 106) over time. D-dimer and CRP average concentration did not significantly differ, 561 μg/L (− 6212–7334) and 27 mg/L (− 32–86) respectively. Ferritin lost statistical significance, both in sensitivity analysis and after adjustment for fibrinogen and D-dimer. Conclusion Lower average concentrations of fibrinogen over time were associated with the presence of clinical pulmonary thromboembolism in patients at the Intensive Care, whereas D-dimer, CRP and ferritin were not. Lower concentrations over time may indicate the consumption of fibrinogen related to thrombus formation in the pulmonary vessels.

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COVID‐19 and Venous Thromboembolism in Intensive Care or Medical Ward

Cited by 52 publications

References 38 publications

Children and young adults hospitalized for severe COVID‐19 exhibit thrombotic coagulopathy

Children and young adults hospitalized for severe COVID‐19 exhibit thrombotic coagulopathy

Blood test dynamics in hospitalized COVID-19 patients: Potential utility of D-dimer for pulmonary embolism diagnosis

Serial markers of coagulation and inflammation and the occurrence of clinical pulmonary thromboembolism in mechanically ventilated patients with SARS-CoV-2 infection; the prospective Maastricht intensive care COVID cohort

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