ABSTRACT
Background : Although the novel coronavirus disease 2019 (COVID-19) has been associated with an increased risk of venous thromboembolism (VTE), different VTE incidences are reported according to the population profile. Aims : To compare risk factors, prophylaxis regimens, laboratory data, incidence and mortality rates of VTE associated with COVID-19 and non-COVID-19 patients, hospitalized in an institution with best practices in thromboprophylaxis. Methods : We retrospectively analyzed all confirmed cases of VTE (pulmonary embolism [PE] and/or deep vein thrombosis [DVT]) reported in electronic medical records diagnosed at admission, during hospitalization or readmitted to the hospital within 90 days after discharge, between January/2020 and February/2021. Characteristics of VTE events associated with COVID-19 and VTE associated with other diseases (non-COVID patients), were compared. Results : Over the study period, 177 patients presented VTE events (63.8% male, mean age 63.8 ± 18.9 years, 38.4% confirmed COVID-19;85% critically ill patients). Clinical characteristics were summarized in Table 1. In contrast to non-COVID group, COVID-19 patients were predominantly male (78% vs. 55%;P = 0.002) and older (66 vs. 61 years old ;P = 0.034), had less clinical risk factors for VTE, and developed VTE more frequently during hospital stay, despite using higher doses of enoxaparin (Tables 1 and 2). Mortality rate was higher in the COVID group (38.2% vs. 5.5%;P < 0.0001). Additionally, COVID group presented higher D-Dimer levels (17481 ± 26278 UI/ ml vs. 7291 ± 11708 UI/ml;P = 0.004), but similar C-reactive protein levels (12.5 ± 11.8 vs.13.8 ± 79.2;P = 0.892). Regarding critically ill patients, COVID-19 was associated with an increased risk of VTE compared to non-COVID group (5.6% [34/602] vs. 0.5% [20/3690], unadjusted OR = 10.98 [95% CI 6.3-19.2;P < 0.00001]) (Table 2). Conclusions : Despite of having less clinical risk factors for VTE and using greater doses of enoxaparin, COVID-19 patients had higher incidence of In-hospital VTE and higher mortality rate. These findings suggest that a hypercoagulability state could be induced by the coronavirus itself. .
ABSTRACT
Background : D-Dimer (DD) values are often elevated in coronavirus disease 2019 (COVID-19), but its role as a diagnostic test of VTE is controversial. Aims : To analyze the performance of DD in the VTE events diagnosis in a cohort of COVID-19 patients. Methods : We retrospectively analyzed, from March/2020 to February/2021, all cases of proven COVID-19 submitted to a compression ultrasound (CUS) or CT pulmonary angiogram (CTPA) to investigate deep venous thrombosis [DVT] and/or pulmonary embolism [PE]. DD levels were recorded at hospital admission and at the day (±24 h) of each imaging studies. DD levels were categorized into 3 groups according to terciles, in order to determine VTE risk. ROC curve analysis was used to determine optimal DD cut-off to predict VTE. Results : From 717 COVID-19 admissions, we identified 169 patients (median age 65 years [20-103], 66% male) submitted to a 208 imaging studies (74 CTPA, 134 CUS). In the overall cohort, 54 (32%) patients had VTE diagnosis according to 62 positive exams (39 CUS and 23 CTPA). Confirmed VTE patients had higher median levels of DD at admission (2364 vs. 831 ng/mL;P = 0.004) and at the day of exam (7013 vs. 1378 ng/mL;P < 0.0001). The AUROC for DD and VTE at admission and at the day of imaging study was 0.72 (95%CI,0.63-0.81) and 0.80 (95%CI,0.73-0.87), respectively. The best DD cut-off point to predict VTE was 2000 ng/mL (86% sensitivity, 63% specificity). Greater values of DD were associated with an increased rate of VTE diagnosis: group I≤1200 ng/mL: 7.6%;group II-1201-5000 ng/mL: 35.8% and group III>5000 ng/mL: 60.3% ( P < 0.001). The OR of group II and III vs. group I was 6.8 (95%CI 2.4-19.3;P < 0.0001) and 18.5 (95%CI6.6-52.0;P < 0.0001), respectively. Conclusions : In a cohort of hospitalized COVID-19 patients, DD test was a good discriminator of VTE events. Serial measurements of DD could help physicians to initiate anticoagulation therapy in COVID-19 patients suspected of VTE diagnosis.