Prevalence of asymptomatic deep vein thrombosis in patients hospitalized with SARS-CoV-2 pneumonia: a cross-sectional study

Abstract

The association between coronavirus disease 2019 (COVID-19) pneumonia and venous thrombotic disorders is still unclear. We assessed the association between COVID-19 infection-related pneumonia and proximal deep-vein thrombosis (DVT) in a cohort of patients admitted to our hospital during the European outbreak in the front line of Cremona, Lombardy. In a single-center cross-sectional study, all patients hospitalized for more than 5 days in Internal Medicine Department with confirmed COVID-19 pneumonia received 2-point compressive ultrasound assessment (CUS) of the leg vein system during a single day. Ninety-four percent of patients received enoxaparin as standard pharmacological prophylaxis for venous thromboembolism. The presence of DVT was defined as incompressibility of popliteal or common femoral vein. Out of 121 patients with COVID-19 pneumonia (mean age 71.8, 66.3% males) hospitalized on March 31st, 70 stayed in hospital for over 5 days and 66 of them underwent CUS of deep venous system of the legs. The presence of asymptomatic DVT was found in 9 patients (13.6%). No symptomatic DVT was found. Patients with DVT showed mean age = 75.7 years, mean D-dimer levels = 4.02 ng/ml and all of them received enoxaparin for thromboprophylaxis, except one. Computed tomography pulmonary angiogram confirmed pulmonary embolism in five patients. One every seven patients with COVID-19-related pneumonia, hospitalized for more than 5 days, had asymptomatic proximal DVT and half of them had confirmed PE despite standard pharmacological thromboprophylaxis. This observational study suggests the need of an active surveillance through CUS in patients hospitalized with acute SARS-COV-2 and underline the need of a more intense thromboprophylaxis.

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.…”

Increasing dosages of low-molecular-weight heparin in hospitalized patients with Covid-19

“…Even though the high mortality rate of patients with Covid-19 and its association with an increased risk of VTE is well established, [ 9 – 13 ] limited data on the effect of antithrombotic prophylaxis on the clinical outcome in Covid-19 are currently available. In China, there was a difference between heparin users and non-users on the 28-day mortality in a sub-group of patients meeting the criteria of sepsis-induced coagulopathy (SIC) or with a sixfold increased levels of D-dimer [ 14 ], but it remains to be established whether these results may be translated to Caucasian populations, which seldom develop disseminated intravascular coagulation [ 15 , 16 ].…”

Reduced macular vessel density in COVID-19 patients with and without associated thrombotic events using optical coherence tomography angiography

“…Thrombotic events are emerging as one of the most relevant sequelae of SARS-CoV-2 infection [9,10]. A high incidence of TE has been described in COVID-19 patients, more so in critically ill patients, reporting variable incidences ranging from 11.5 to 27% [1,[10][11][12][13][14]. Although PE represents the most frequent thrombotic manifestation associated with the infection [1], TE, venous and arterials, have been also described in other organs such as the eye [15].…”