Combined Use of Wells Scores and D-dimer Levels for the Diagnosis of Deep Vein Thrombosis and Pulmonary Embolism in COVID-19: A Retrospective Cohort Study

Abstract

IntroductionDeep vein thrombosis (DVT) and pulmonary embolism (PE) are key complications of coronavirus disease 2019 . The study's primary outcome was assessing the utility of Wells DVT, Wells PE scores, and D-dimers in diagnosing DVT and PE. Secondary outcomes were the risk factors for the development of PE and DVT in COVID-19 patients. Materials and methodsWe compared COVID-19 patients with a positive and negative lower extremity (LE) duplex. A similar approach was made for patients who underwent imaging for PE. ConclusionsThe combined approach of using a Wells DVT score of 3 in suspected DVT and Wells PE score of 4 in suspected PE and D-dimers of 500 ng/ml may be used to diagnose PE and DVT in COVID-19. Venous thromboembolism (VTE) occurrence in COVID-19 is associated with non-traditional risk factors such as intubation and higher severity of systemic inflammation, and these patients may benefit from more aggressive testing for VTE.

Therapeutic-dose anticoagulation or thromboprophylaxis with low-molecular-weight heparin for moderate Covid-19: meta-analysis of randomized controlled trials

“…However, biomarkers of coagulation (e.g., d-dimer, fibrinogen level, and activated partial thromboplastin time) or inflammation (Leukocyte count, C-reactive protein) failed to discriminate between patients with or without thrombotic complications [ 30 ]. Therapeutic-dose anticoagulation should be reserved for patients with a documented venous thrombotic event or those showing high probability of thromboembolism defined by a Wells score of 3 in suspected deep vein thrombosis and a Wells score of 4 in suspected pulmonary embolism and D-dimers of 500 ng/mL and above [ 31 ].…”

Utility of probability scores for the diagnosis of pulmonary embolism in patients with SARS-CoV-2 infection: A systematic review

“…In the study by Raj et al, a Wells score ≥4 in combination with a D-dimer ≥500 ng/mL showed a sensitivity of 96.1% 25 . Finally, Polo Friz et al analyzed the dichotomized Wells score in 40 COVID-19 patients with suspected PE 26 .…”

“…Table 3 shows the characteristics of the studies included. Thirteen studies were included, all of which were retrospective cohort studies 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 .…”

“…Among the 13 studies selected, five models were evaluated (Wells score, Geneva score, YEARS algorithm, and the PERC and PEGeD rules). The diagnostic yield of the Wells score was analyzed in six studies 21 , 22 , 23 , 24 , 25 , 26 . A Swiss work analyzed the dichotomized Wells score together with D-dimer 27 and a German study analyzed the Wells score together with a point-of-care lung ultrasound 28 .…”

Role of P-Selectin in the Development of Hemostasis Disorders in COVID-19

“…It is worrying that in the series described, this complication occurred in patients despite routine heparin prophylaxis. With the more aggressive variant of thrombotic complications observed in lethal cases, extensive microthrombosis of both lungs is noted, extending to the entire respiratory area (Raj et al, 2021). A more detailed follow-up revealed diffuse and severe endothelial and alveolar damage with disruption of alveolar membranes, perialveolar microangiopathy, and widespread microthrombosis with intra alveolar hemorrhages.…”