Examining D-dimer and Empiric Anti-coagulation in COVID-19-Related Thrombosis

Abstract

Thrombosis is thought to occur frequently in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to elucidate the relationship between macro/microvascular thrombosis, D-dimer levels, and empiric anticoagulation in coronavirus disease 2019 . MethodsThis was an exploratory prospective, single-site, observational study. Adult emergency department patients with COVID-19 requiring hospitalization received a point-of-care lower extremity venous duplex ultrasound. The primary endpoint was thromboembolism and associated D-dimer level. Secondary endpoints included rates of micro and macro thrombotic complications as well as empiric anticoagulant use. ResultsBetween January 13 th and April 12 th 2021, 52 patients were enrolled. Median D-dimer at presentation was 650 ng/mL (range 250-10,000 ng/mL) among patients with negative duplex studies. During hospitalization, 18 patients underwent 20 additional studies assessing for venous thromboembolism (VTE). These studies yielded one deep vein thrombosis (DVT) diagnosis. Among patients with negative studies median Ddimer was 1,246 ng/mL (range 329-10,000 ng/mL). Two patients experienced microvascular complications. Seven patients were started on empiric full dose anticoagulation. ConclusionWhile VTE remains a major concern amongst patients with COVID-19, the normal D-dimer cut off of >500 ng/mL likely should not be used to initiate further VTE workup. Additionally, moderately elevated D-dimer did not correlate strongly with microvascular complications and may not be relevant in the decision to initiate empiric anticoagulation.

Trombose venosa profunda de membros inferiores em pacientes com covid-19

“…A análise dos tratamentos empregados para o manejo da TVP de membros inferiores em pacientes com covid-19 sugere que a administração precoce de anticoagulante profilático beneficiaria o prognóstico de pacientes críticos com pneumonia por covid-19 e, provavelmente, reduziria as taxas de eventos tromboembólicos. Entretanto, há controvérsias na literatura 14,28,30,41,44,45 .…”

Deep vein thrombosis of lower limbs in patients with COVID-19

“…However, there are inconsistencies in the literature. 14,28,30,41,44,45 The studies included in this review describe patients with COVID-19 of varying degrees of severity and from different population groups.…”

Determination of some hematological, biochemical parameters and vitamin D receptor gene polymorphism in Kurdish patients with COVID-19 in Erbil city

“…According to certain research, people with CoV-2 may be treated with empiric complete anticoagulation or have a workup for venous thromboembolism (VTE) if their D-dimer levels are two to four times higher than the typical cut-off number [49]. It has been discovered that D-dimer levels are related to thrombosis development and patient death in CoV-2 patients [ [50], [51], [52]. To treat individuals with CoV-2, some advice suggests that coagulation indicators, such as D-dimer levels, be tested first [53].…”