Utility of D-dimer in predicting venous thromboembolism in non-mechanically ventilated COVID-19 survivors

Nauka, Peter; Baron, Sarah; Assa, Andrei; Mohrmann, Laurel; Jindal, S.K.; Oran, Erick; Glazman-Kuczaj, Galina; Southern, William N.; Chekuri, Sweta

doi:10.1016/j.thromres.2020.12.023

Cited by 11 publications

(9 citation statements)

References 7 publications

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“…Among patients who underwent CT pulmonary angiography, the closest D-dimers levels to imaging request had a positive predictive value for pulmonary embolism of approximately 70% when values approached 5 µg/mL [26] . In non-mechanically ventilated patients, D-dimers levels >5 µg/mL at admission was associated with venous thromboembolism in 46.7% of cases [27] . These data are from retrospective studies in which no systematic screening for thrombosis was applied, but all converge on a D-dimers threshold of 5 µg/mL.…”

Section: Methodsmentioning

confidence: 96%

See 1 more Smart Citation

Prevention of venous thromboembolism and haemostasis monitoring in patients with COVID-19: Updated proposals (April 2021)

Garrigue

Albaladéjo

Blais

et al. 2021

Anaesthesia Critical Care & Pain Medicine

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Section: Methodsmentioning

confidence: 96%

“…Initially proposed as a marker of thrombotic risk in COVID-19 patients, fibrinogen levels have not been associated with thrombotic risk in most studies and therefore cannot be used to identify patients at risk for thrombosis [27] , [41] .…”

Section: Methodsmentioning

confidence: 99%

Prevention of venous thromboembolism and haemostasis monitoring in patients with COVID-19: Updated proposals (April 2021)

Garrigue

Albaladéjo

Blais

et al. 2021

Anaesthesia Critical Care & Pain Medicine

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“…D dimer is associated with intravascular coagulation and venous thromboembolism in COVID-19 (38) and other clinical situations (39) and it is considered a marker of disease severity (40). Our ndings open the way to further study the roll of micro-thrombosis in the pathogenesis of delirium, as proposed by MacLullich (37).…”

Section: Discussionmentioning

confidence: 62%

Delirium in Covid-19 Patients: Incidence, Risk Factors and Early Outcomes.

Mejía-Mantilla

Gempeler

Gaviria

et al. 2021

Preprint

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Background Delirium is a frequent event in severely ill patients; its incidence and prevalence varies depending on several factors; Covid has been associated to high incidence of delirium leading to speculation of specific mechanisms of neurotoxicity by the SARS-CoV-2. We present the analysis of risk factors for delirium incidence and the impact of delirium in the functional outcomes. Methods We included patients admitted to a referral center in Cali, Colombia between April and August 2020. Patients were evaluated for demographics, severity of disease, comorbidities, clinical outcomes, delirium and survival at discharge. We evaluated the association of patient characteristics and disease factors with delirium incidence by multivariate analysis (Hosmer and Lemeshow) and the associations of delirium with functional outcome at discharge Results Among 333 patients, 58 (17.42%. 95% CI: 13.62–21.77%) presented delirium 16 (IQR: 11 − 20) days after symptom onset. Patients with delirium were older, reported muscular weakness more often, had a higher NEWS2 score at admission, and had more comorbidities (mainly Diabetes Mellitus II). Multivariate analysis of hospitalization events and treatments found mechanical ventilation as the only significant covariate. The association between need for mechanical ventilation and delirium development was estimated at OR = 11.72, (95%CI = 4.16–34.23). Patients who developed delirium had a higher frequency of functional impairment: mRs > 2 (70.7% vs 24.7%, p < 0.001) and had a prolonged ICU stay (median 13 days, IQR 8–21 vs median 5, IQR 3–10 days, p < 0.0001) compared to patients without delirium. Conclusion Our data show that premorbid functional status, the severity of respiratory disfunction and the presence of inflammatory markers are determinant in the risk of delirium; we believe that delirium might not be specially related to SARS-CoV-2 infections, its high frequency during this pandemic could be the result of concurring factors shared between critically-ill patients and severe COVID-19 patients. Further research is granted to clarify this aspect

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“…16 A novel aspect of COVID-19 is the association of D-dimer to illness severity, 17 and this biomarker has been proposed as predictive of VTE. [18][19][20] Pharmacologic VTE prophylaxis, even at low doses, is associated with a risk of bleeding, and given aggressive prophylaxis regimens used in patients with COVID-19, the risk of bleeding must be taken into account to optimize patient outcomes. 21,22 Therefore, it would be ideal to apply pharmacologic VTE prophylaxis to only those patients with COVID-19 most likely to have a favorable risk : benefit balance.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…Hypothesized mechanisms include the effect of neutrophil extracellular traps, 12,13 transient presence of lupus anticoagulants, 14,15 and perhaps an H1N1‐like distress leukocyte adhesion to the vein walls that produce inflammatory molecules 16 . A novel aspect of COVID‐19 is the association of D‐dimer to illness severity, 17 and this biomarker has been proposed as predictive of VTE 18–20 . Pharmacologic VTE prophylaxis, even at low doses, is associated with a risk of bleeding, and given aggressive prophylaxis regimens used in patients with COVID‐19, the risk of bleeding must be taken into account to optimize patient outcomes 21,22 .…”

Section: Introductionmentioning

confidence: 99%

Biomarker derived risk scores predict venous thromboembolism and major bleeding among patients with COVID‐19

Woller

Stevens²,

Bledsoe³

et al. 2022

Research and Practice in Thrombosis and Haemostasis

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Background Venous thromboembolism (VTE) risk is increased in patients with COVID‐19 infection. Understanding which patients are likely to develop VTE may inform pharmacologic VTE prophylaxis decision making. The hospital‐associated venous thromboembolism–Intermountain Risk Score (HA‐VTE IMRS) and the hospital‐associated major bleeding–Intermountain Risk Score (HA‐MB IMRS) are risk scores predictive of VTE and bleeding that were derived from only patient age and data found in the complete blood count (CBC) and basic metabolic panel (BMP). Objectives We assessed the HA‐VTE IMRS and HA‐MB IMRS for predictiveness of 90‐day VTE and major bleeding, respectively, among patients diagnosed with COVID‐19, and further investigated if adding D‐dimer improved these predictions. We also reported 30‐day outcomes. Patients/Methods We identified 5047 sequential patients with a laboratory confirmed diagnosis of COVID‐19 and a CBC and BMP between 2 days before and 7 days following the diagnosis of COVID‐19 from March 12, 2020, to February 28, 2021. We calculated the HA‐VTE IMRS and the HA‐MB IMRS for all patients. We assessed the added predictiveness of D‐dimer obtained within 48 hours of the COVID test. Results The HA‐VTE IMRS yielded a c‐statistic of 0.70 for predicting 90‐day VTE and adding D‐dimer improved the c‐statistic to 0.764 with the corollary sensitivity/specificity/positive/negative predictive values of 49.4%/75.7%/6.7%/97.7% and 58.8%/76.2%/10.9%/97.4%, respectively. Among hospitalized and ambulatory patients separately, the HA‐VTE IMRS performed similarly. The HA‐MB IMRS predictiveness for 90‐day major bleeding yielded a c‐statistic of 0.64. Conclusion The HA‐VTE IMRS and HA‐MB IMRS predict 90‐ and 30‐day VTE and major bleeding among COVID‐19 patients. Adding D‐dimer improved the predictiveness of the HA‐VTE IMRS for VTE.

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Utility of D-dimer in predicting venous thromboembolism in non-mechanically ventilated COVID-19 survivors

Cited by 11 publications

References 7 publications

Prevention of venous thromboembolism and haemostasis monitoring in patients with COVID-19: Updated proposals (April 2021)

Prevention of venous thromboembolism and haemostasis monitoring in patients with COVID-19: Updated proposals (April 2021)

Delirium in Covid-19 Patients: Incidence, Risk Factors and Early Outcomes.

Biomarker derived risk scores predict venous thromboembolism and major bleeding among patients with COVID‐19

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