Incidence of deep vein thrombosis through an ultrasound surveillance protocol in patients with COVID-19 pneumonia in non-ICU setting: A multicenter prospective study

Pieralli, Filippo; Pomero, Fulvio; Giampieri, Margherita; Marcucci, Rossella; Prisco, Domenico; Luise, Fabio; Mancini, Antonio; Milia, Alessandro; Sammicheli, Lucia; Tassinari, Irene; Caldi, Francesca; Innocenti, Francesca; Faraone, Antonio; Beltrame, Chiara; Pini, Riccardo; Ungar, Andrea; Fortini, Alberto

doi:10.1371/journal.pone.0251966

Cited by 23 publications

(20 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results and opinion are in line with Pieralli et al [ 17 ], that suggested a surveillance protocol by serial CUS to identify patients with DVT, helping its detection and avoiding its possible consequences.…”

Section: Discussionsupporting

confidence: 92%

Compressive ultrasound can predict early pulmonary embolism onset in COVID patients

et al. 2022

View full text Add to dashboard Cite

Purpose To evaluate the usefulness of compressive ultrasound (CUS) for the diagnosis of deep vein thrombosis (DVT) in patients with SARS-CoV-2-related infection. Methods 112 hospitalized patients with confirmed SARS-CoV-2 infection were retrospectively enrolled. CUS was performed within 2 days of admission and consisted in the assessment of the proximal and distal deep venous systems. Lack of compressibility, or direct identification of an endoluminal thrombus, were the criteria used for the diagnosis of DVT. Pulmonary embolism (PE) events were investigated at computed tomography pulmonary angiography (CTPA) within 5 days of follow-up. Logistic binary regression was computed to determine which clinical and radiological parameters were independently associated with PE onset. Results Overall, the incidence of DVT in our cohort was about 43%. The most common district involved was the left lower limb (68.7%) in comparison with the right one (58.3%) while the upper limbs were less frequently involved (4.2% the right one and 2.1% the left one, respectively). On both sides, the distal tract of the popliteal vein was the most common involved (50% right side and 45.8% left side). The presence of DVT in the distal tract of the right popliteal vein (OR = 2.444 95%CIs 1.084–16.624, p = 0.038), in the distal tract of the left popliteal vein (OR = 4.201 95%CIs 1.484–11.885, p = 0.007), and D-dimer values (OR = 2.122 95%CIs 1.030–5.495, p = 0.003) were independently associated with the onset on PE within 5 days. Conclusions CUS should be considered a useful tool to discriminate which category of patients can develop PE within 5 days from admission.

show abstract

Section: Discussionsupporting

confidence: 92%

Compressive ultrasound can predict early pulmonary embolism onset in COVID patients

et al. 2022

View full text Add to dashboard Cite

show abstract

“…7,8 Even while on anticoagulation patients develop TEs. 25,26 We have observed that 79% of our patients had a hypercoagulable TEG tracing at the time of admission and 30.23% (13/43) had a documented TE during ICU stay even when they were on therapeutic doses of anticoagulants. The high incidence of TE in CAC might be due to the widespread inflammation and severity of the infection which in turn causes widespread clot formation.…”

Section: Resultsmentioning

confidence: 69%

“…The cumulative incidence of TE in COVID‐19 patients admitted to ICU is around 30% and systemic anticoagulation has been recommended to patients requiring ICU admission 7,8 . Even while on anticoagulation patients develop TEs 25,26 . We have observed that 79% of our patients had a hypercoagulable TEG tracing at the time of admission and 30.23% (13/43) had a documented TE during ICU stay even when they were on therapeutic doses of anticoagulants.…”

Section: Discussionmentioning

confidence: 68%

Utility of Thromboelastography and velocity curve derivative in diagnosing COVID‐19 associated coagulopathy

Mohan

Wilson

Paonam

et al. 2022

Int J Lab Hematology

View full text Add to dashboard Cite

Background COVID‐19 associated coagulopathy (CAC) can either be localized or systemic hypercoagulable state with increased risk of thromboembolism. This study looked into the usefulness of Thromboelastography (TEG) and the velocity curve (V‐curve) derivative from TEG in diagnosing and differentiating different stages of CAC. Materials and Methods A prospective single cohort study of RT‐PCR confirmed COVID‐19 patients was carried out for 2 weeks. Severe COVID‐19 patients in the adult critical care units with a TEG report were recruited for the study. Citrated kaolin TEG was performed on the day of admission before anticoagulation. TEG parameters included were R and K time, alpha angle, maximum amplitude, clotting index, lysis at 30 min. The first‐degree velocity curve of TEG is plotted as V‐curve which extrapolates thrombus generation potential. Parameters analyzed were the maximum rate of thrombus generation as well as thrombus generated (TG). Results The study included 43 patients with an average age of 58.34 (±15.35). TEG as well as V‐curve of all the patients were hypercoagulable compared with age‐matched reference range. We had 79.06% of patients in hypercoagulable stage. The mortality rate was 32.56% and 30.23% developed thrombotic incidents. Patients who succumbed to death had prolonged PT, aPTT, MA, Ly30, with a reduced TG (p < .05). The presence of fibrinolysis was associated with thromboembolism (OR = 6.76, CI = 1.48–25.82). Repeat TEG was done randomly in 11 patients and revealed a persistent hypercoagulable stage with increasing fibrinolysis activity. Conclusion TEG is a useful tool in diagnosing and categorizing Coagulopathy associated with COVID‐19.

show abstract

“…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.…”

Section: Discussionmentioning

confidence: 80%

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

Olgers

Lieveld²,

Kok

et al. 2022

J Ultrasound

View full text Add to dashboard Cite

Purpose Patients with COVID-19 have an increased risk for venous thrombo-embolism (VTE), especially pulmonary embolism. The exact prevalence of asymptomatic DVT is not known, as is the usefulness of screening for DVT in patients admitted to ward with COVID-19. We have studied the prevalence of asymptomatic DVT. Methods We performed a cross-sectional observational multi-center study at four university medical centers in The Netherlands. All adult patients admitted with COVID-19 to a medical ward were eligible for inclusion, including patients who were transferred back from the ICU to the ward. The study protocol consisted of weekly cross-sectional rounds of compression ultrasound. Results In total, 125 patients were included in the study. A significant proportion of patients (N = 34 (27%)) had developed a VTE during their admission for COVID-19 before the study ultrasound was performed. In most VTE cases (N = 27 (79%)) this concerned pulmonary embolism. A new asymptomatic DVT was found in 5 of 125 patients (4.0%; 95% CI 1.3–9.1%) (Table 2). Nine patients (7.2%; 95% CI 3.3–13.2%) developed a VTE (all PE) diagnosed within 28 days after the screening US was performed. Conclusion We have shown a low prevalence (4%) of newly discovered asymptomatic DVT outside the ICU-setting in COVID-19 patients. Despite this low prevalence, nine patients developed PE (7%) within 28 days after ultrasound. This favors the hypothesis of local thrombus formation in the lungs. Based on our findings and literature, we do not recommend US-screening of asymptomatic patients with COVID-19 admitted to the ward.

show abstract

Incidence of deep vein thrombosis through an ultrasound surveillance protocol in patients with COVID-19 pneumonia in non-ICU setting: A multicenter prospective study

Cited by 23 publications

References 31 publications

Compressive ultrasound can predict early pulmonary embolism onset in COVID patients

Compressive ultrasound can predict early pulmonary embolism onset in COVID patients

Utility of Thromboelastography and velocity curve derivative in diagnosing COVID‐19 associated coagulopathy

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

Contact Info

Product

Resources

About