Deep Venous Thrombosis in COVID-19 Patients: A Cohort Analysis

Abstract

Deep venous thrombosis (DVT) is a severe complication of coronavirus disease 2019 (COVID-19). The purpose of this study was to study the prevalence, risk factors, anticoagulant therapy and sex differences of DVT in patients with COVID-19. The enrolled 121 hospitalized non-ventilator patients were confirmed positive for COVID-19. All suspected patients received color Doppler ultrasound (US) to screen for DVT in both lower extremities. Multivariate logistic regression was performed to identify risk factors related to DVT in COVID-19 patients. DVT was found in 48% of the asymptomatic COVID-19 patients with an increased PADUA or Caprini index using US scanning. The multivariate logistic regression determined that age (OR, 1.05; p = .0306), C-reactive protein (CRP) (OR, 1.02; p = .0040), and baseline D-dimer (OR, 1.42; p = .0010) were risk factors among COVID-19 patients. Although the most common DVT location was infrapopliteal (classes I and II), higher mortality in DVT-COVID-19 patients was confirmed. DVT-COVID-19 patients presented significant increases in CRP, neutrophil count, and D-dimer throughout the whole inpatient period compared to non-DVT-COVID-19 patients. Although anticoagulation therapy accelerated the recovery of lymphocytopenia in DVT patients, men DVT-COVID-19 patients with anticoagulant therapy showed significant higher CRP and neutrophil count vs. lymphocyte count (N/L) ratio, but showed lower lymphocyte counts compared to women DVT-COVID-19 patients. DVT is common in COVID-19 patients with high-risk factors, especially for older age and higher CRP and baseline D-dimer populations. It is important to consider sex differences in anticoagulant therapy among DVT-COVID-19 patients.

Impact of the COVID-19 pandemic on radiology department emergency ultrasound utilization

“…The female-only group also demonstrated a relative increase in extremity duplex exams, 5.3% of the study population in 2019 compared to 8.3% in 2020. Thromboembolism is an established complication of COVID-19 [24,25] so an increase in the percentage of these examinations performed would be an expected finding. In the pandemic cohort, there were 57 extremity duplex exams performed and 8 of these studies demonstrated venous thromboses.…”

Diagnostic Value of D-Dimer in COVID-19: A Meta-Analysis and Meta-Regression

“… 44 Coincidentally, initial elevated levels of D-dimer in baseline diminished after anticoagulant therapy with LMWH in DVT-COVID-19 patients and continuously higher than non-DVT-COVID-19 patients, indicating changes of D-dimer present an improvement in hypercoagulable state as well as a stable biomarker for anticoagulant effect in COVID-19 therapy. 45 Recently, researchers found D-dimer levels could affect anticoagulant doses. Prophylactic dose of heparin has been revealed its efficacy and better prognosis among users with D-dimer >6 times the upper limit of normal value (ULN) by improving 28-day mortality than that of nonusers (32.8 vs 52.4%) while users with D-dimer ≤1 ULN of no benefit.…”

The MiR-320 Family Is Strongly Downregulated in Patients with COVID-19 Induced Severe Respiratory Failure

“…The miRNA-320 family has already been described in patients with deep vein thrombosis (DVT) [ 25 , 26 ]. DVT is also a severe complication of COVID-19 patients and, therefore, the identification of high-risk COVID-19 patients is important to promptly initiate thrombosis prophylaxis [ 27 ]. In contrast to our findings, Jiang et al reported a significant up-regulation of miRNA-320a and miRNA-320b correlating with D-dimer concentrations in DVT patients, but not in post-thrombotic syndrome [ 25 ].…”