Incidence of Deep Venous Thrombosis in Patients With COVID‐19 and Pulmonary Embolism

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.

Estimation of Admission D-dimer Cut-off Value to Predict Venous Thrombotic Events in Hospitalized COVID-19 Patients: Analysis of the SEMI-COVID-19 Registry

“…In our work, the overall prevalence of VTE was 2.2%, lower than previously described, [4][5][6][7][8][9][10][12][13][14][15] even for patients admitted to conventional hospital wards without active radiological screening for VTE. 5,6,8,12,15 In non-critical hospitalized patients, the reported rates are 3.3% and 6.6%, 5,12 lower than those in studies on patients in the ICU, with a prevalence between 16.7 and 28%.…”

“…[1][2][3] VTE has been detected in 3 to 46% of the patients with COVID-19, with the highest prevalence in patients in intensive care units (ICU). [4][5][6][7][8][9][10][11][12][13][14][15][16][17] These rates are higher than those reported in non-COVID-19 patients [18][19][20] and have been related to a higher mortality. 5 The diagnosis of VTE in patients with COVID-19 is challenging because its clinical manifestations and analytical findings can be misdiagnosed.…”

“…34 Related to these observations, in a recent prospective observational study on 26 COVID-19 hospitalized patients who developed PE, DVT was only detected in 7.7% (95% CI: 3.6-11.7%) of the cases after systematic screening with compression ultrasound. 9 This points to the possibility that local lung inflammation and pulmonary microthrombosis are especially prominent in COVID-19. 11 Similar findings have been observed in our study, with a higher proportion of patients with PE alone (1.4%) than DVT alone (0.4%) or in combination (0.2%).…”

Imaging Evaluation of Pulmonary and Non-Ischaemic Cardiovascular Manifestations of COVID-19

“…Compressive ultrasound (CUS) for DVT [ 143 ] should be used for patients hospitalized for COVID-19 either with clinical symptoms of deep vein thrombosis (DVT). When there are not clinical symptoms elevated D-dimers levels or DVT clinical probability (Wells score > 2) are useful to guide clinicians.…”

“…In a prospective observational study, consecutive COVID-19 patients with a diagnosis of PE were ultrasound screened for DVT in the lower extremities [ 143 ]. DVT was diagnosed in the emergency department in about 7% of patients who had central and bilateral PE.…”