Asymptomatic deep vein thromboses in prolonged hospitalized COVID-19 patients

Abstract

High incidence of venous thromboembolic (VTE) events in coronavirus disease 2019 (COVID-19) patients has been reported despite pharmacologic thromboprophylaxis. We performed prospective bilateral lower extremity ultrasound evaluation of prolonged hospitalized COVID-19 ward patients from our institution without clinical suspicion of deep vein thrombosis (DVT). A total of 102 patient were included in the study. All patients were receiving pharmacologic thromboprophylaxis, the majority in intermediate or therapeutic doses. Asymptomatic DVT was detected in 26/102 (25.5%) patients: 22 had distal and four had proximal DVT, six had bilateral leg involvement. Pulmonary embolism was highly prevalent (17/70, 24.3%) but similarly grouped among patients with and without asymptomatic DVT. In total 37.2% of patients included in the study were recognized as having VTE.

Incidence and risk factors for venous and arterial thromboses in hospitalized patients with coronavirus disease 2019: data on 4014 patients from a tertiary center registry

“…Among 102 patients without clinically overt DVT, asymptomatic DVT was detected in 25.5% patients despite all patients receiving thromboprophylaxis. The frequency of DVT reached 60% in mechanical ventilation survivors ( 24 ), which confirmed previously published reports. Thus, the more thromboses are searched for, the more they are discovered.…”

“…Known thrombophilia is a reported predictive factor for both asymptomatic thromboses ( 24 ) and VTE in general, as shown in the current study. However, the definition of thrombophilia status is vague and hard to quickly obtain, even if patients were previously tested or are currently suspected.…”

“…There is considerable variation in the frequency of VTE in the literature, and VTE events develop despite the use of pharmacologic thromboprophylaxis. Moreover, thromboprophylaxis might ameliorate and mask the clinical presentation during duration of therapy ( 24 ). The VTE incidence/detection rate seems to depend on COVID-19 severity in investigated cohorts and whether active screening for VTE was performed.…”

Screening for asymptomatic deep vein thrombosis in COVID-19 patients admitted to the medical ward: a cross-sectional study

“…However, in seven out of eight cases, it was only a distal DVT giving an incidence of proximal DVT of 2.3%. More recent studies confirm the low prevalence of asymptomatic proximal DVT [ 13 , 14 ]. In conclusion, all besides one study showed a low incidence of proximal DVT outside the ICU.…”

Comparison of IMPROVE, modified IMPROVE, IMPROVEDD, Padua and CHA2DS2-VASC risk scores for venous and arterial thrombotic events prediction in hospitalized COVID-19 patients

“…All scores had somewhat better properties for DVT then PE discrimination which might reflect the challenges of PE diagnosis in COVID-19 patients that might be not sufficiently stable to undergo diagnostic procedures. DVT evaluation is more easily performed and often unexpectedly high event rates are encountered if screening of asymptomatic patients can be utilized [10] . In contrast to VTE that associates with more severe COVID-19 presentation and high functional impairment, AT seem to be associated with milder severity of COVID-19 symptoms and more clear clinical presentation, often in the context of previously established chronic metabolic comorbidities [4] .…”