Duplex Ultrasound Screening for Deep and Superficial Vein Thrombosis in COVID‐19 Patients

Abstract

Background There is growing evidence regarding the venous thromboembolic (VTE) pathophysiology of coronavirus disease 2019 (COVID‐19). Several studies have reported varying incidences of this disease. Objectives The main purpose of this study was to determine the real incidence of deep or superficial vein thrombosis in COVID‐19. The study also aimed to identify risk and protective factors for VTE. Methods Patients were consecutively enrolled and assessed with a bilateral Duplex ultrasonography of lower limbs during hospitalization. The exam was repeated weekly until discharge, and then follow‐up for 1 month. Results Two‐hundred and thirty‐three patients were enrolled. Mean age was 54.4 years (SD 12.7) and 47.8% were female. About 127 patients (54.5%) had comorbidities. At enrollment, patients were normotensive and had normal saturation (95.6%—SD 1.6, with a respiratory rate of 19.1 rpm—SD 4.0), with 130 needing at least supplementary oxygen therapy (55.8%). About 147 patients (63.1%) had at least 1 Duplex ultrasonography study performed and 1.7% had 5 or more studies. One patient had a distal posterior tibial vein thrombosis, which showed signs of chronicity and was congruent with the patient history. Therefore, the incidence of thrombotic events was nearly zero. Discussion Our study results suggest that performing a Duplex Ultrasonography screening protocol in stable COVID‐19 patient populations, who may need hospitalization but are without symptoms of vein thrombosis, is not founded. We presumably emphasize the advantage of using intermediate LMWH doses as well as early walking in COVID‐19 patients.

Therapeutic anticoagulation to prevent thrombosis, coagulopathy, and mortality in severe COVID‐19: The Swiss COVID‐HEP randomized clinical trial

“…The yield of screening for asymptomatic proximal DVT was null in our trial and should not be generalized in clinical practice. This is in agreement with previous prospective studies, the HEP‐COVID, and X‐COVID‐19 trials showing a low prevalence of asymptomatic proximal DVT of 0% to 2.9% among acutely ill medical patients 14,17,30‐32 . In the ICU, we did not find the elevated (5%–23%) risks found by previous prospective studies 33‐37 …”

“…This is in agreement with previous prospective studies, the HEP-COVID, and X-COVID-19 trials showing a low prevalence of asymptomatic proximal DVT of 0% to 2.9% among acutely ill medical patients. 14,17,[30][31][32] In the ICU, we did not find the elevated (5%-23%) risks found by previous prospective studies. [33][34][35][36][37] Our trial has several strengths.…”

Efficacy and safety of sonographer discretion to terminate a venous duplex ultrasound for diagnosis of deep vein thrombosis in coronavirus disease 2019 patients

“…Our study found an overall acute DVT rate of 29.2%, with a 27.5% rate of acute lower extremity DVTs and a 36.6% rate of upper extremity DVTs. Studies evaluating screening have demonstrated no significant benefit in asymptomatic patients with COVID-19, further supported by findings that 67.6% of patients with a PE did not have a prior DVT 17 , 18 , 19 . Current guidelines from the National Institute of Health (NIH) and American College of Chest Physicians (CHEST) do not recommend routine screening, however clinicians should have a low threshold to perform VDUS examinations in patients with a clinical suspicion for DVT 20 , 21 .…”

Pathological Effects of SARS-CoV-2 Associated with Hematological Abnormalities

“…It is crucial to quickly diagnose the infection and conduct blood tests like peripheral blood smear, platelet count, PT, aPTT, fibrinogen, and D-dimer levels upon admission, evaluating the risks, using smart ways to prevent thromboprophylaxis (blood clots), and using treatments that specifically fight clotting with regular monitoring for critically ill patients [ 116 ]. Venous compression Duplex scans are suggested for ICU patients upon admission and periodically thereafter to detect and prevent deep vein thrombosis (DVT), alongside vigilance for signs of pulmonary embolism (PE) [ 116 , 124 ]. Diagnosis of disseminated intravascular coagulation (DIC) does not always warrant anticoagulation unless clotting is present.…”