Incidence of deep vein thrombosis among non‐ICU patients hospitalized for COVID‐19 despite pharmacological thromboprophylaxis

Abstract

Background A remarkably high incidence of venous thromboembolism (VTE) has been reported among critically ill patients with COVID‐19 assisted in the intensive care unit (ICU). However, VTE burden among non‐ICU patients hospitalized for COVID‐19 that receive guideline‐recommended thromboprophylaxis is unknown. Objectives To determine the incidence of VTE among non‐ICU patients hospitalized for COVID‐19 that receive pharmacological thromboprophylaxis. Methods We performed a systematic screening for the diagnosis of deep vein thrombosis (DVT) by lower limb vein compression ultrasonography (CUS) in consecutive non‐ICU patients hospitalized for COVID‐19, independent of the presence of signs or symptoms of DVT. All patients were receiving pharmacological thromboprophylaxis with either enoxaparin or fondaparinux. Results The population that we screened consisted of 84 consecutive patients, with a mean age of 67.6 ± 13.5 years and a mean Padua Prediction Score of 5.1 ± 1.6. Seventy‐two patients (85.7%) had respiratory insufficiency, required oxygen supplementation, and had reduced mobility or were bedridden. In this cohort, we found 10 cases of DVT, with an incidence of 11.9% (95% confidence interval [CI] 4.98‐18.82). Of these, 2 were proximal DVT (incidence rate 2.4%, 95% CI −0.87‐5.67) and 8 were distal DVT (incidence rate 9.5%, 95% CI 3.23‐5.77). Significant differences between subjects with and without DVT were D‐dimer > 3000 µg/L (P < .05), current or previous cancer (P < .05), and need of high flow nasal oxygen therapy and/or non‐invasive ventilation (P < .01). Conclusions DVT may occur among non‐ICU patients hospitalized for COVID‐19, despite guideline‐recommended thromboprophylaxis.

Lesson by SARS-Cov 2 disease (COVID-19): whole body CT angiography detection of relevant and other/incidental systemic vascular findings

“…Additional vascular events widely ranged from pulmonary infarction and ischemic brain injury to infarction of abdominal parenchymal organs with a similar frequency distribution between ICU and no-ICU patients which was suggestive of a sort of dysregulation of the coagulation process even in less severe patients. This nding is in agreement with data by Santoliquido et al who reported a 11.9% incidence of deep vein thrombosis in a cohort of 84 no-ICU COVID-19 patients receiving thromboprophylaxis [23]. Altogether, these observations are of utmost clinical relevance as anticoagulation therapy has been shown to signi cantly improve patient outcome when started early, instead of sole prophylaxis, at least in moderate-high risk patients [24][25][26][27].…”

Venous Thrombo-Embolism in Hospitalized SARS-CoV-2 Patients Treated with Three Different Anticoagulation Protocols: Prospective Observational Study

“…Data regarding VTE rate outside the ICU are more limited, but also suggest a possibly increased rate (range 3% to 6%) [ 16 , 25 ]. Other studies focused on Covid-19 patients also show a higher rate of DVT (65–69% in ICU patients [ 26 , 27 ], 11.9–21% in general ward patients [ 9 , 28 , 29 ]). Unlike what has been described by other authors [ 9 , 28 ], in our study most DVTs were proximal (84.6%) and only 15.4% of DVTs were distal.…”

“…Other studies focused on Covid-19 patients also show a higher rate of DVT (65–69% in ICU patients [ 26 , 27 ], 11.9–21% in general ward patients [ 9 , 28 , 29 ]). Unlike what has been described by other authors [ 9 , 28 ], in our study most DVTs were proximal (84.6%) and only 15.4% of DVTs were distal. In addition, we reported PE localized in segmental branches of the pulmonary artery in most of the patients and a strong association was found between PE and DVT, suggesting a typical thromboembolic origin.…”

“…In our study, higher concentrations of these biomarkers seem to be related to VTE. Moreover, according to the literature our data showed that VTE was significantly associated with elevated D-dimer [ 9 , 19 , 28 ], and with positive pressure respiratory assistance [ 28 ]. Findings from the present study further support the inclusion of D-dimer measurement in VTE risk assessment among acutely ill hospitalized patients with or without COVID-19.…”

Thromboprophylaxis: balancing evidence and experience during the COVID-19 pandemic

“…In the inpatient setting, the prevalence of VTE ranges from 3 to 85%, as detailed in Fig. 1 [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”