Utility of D-dimers and intermediate-dose prophylaxis for venous thromboembolism in critically ill patients with COVID-19

Predicting Venous Thromboembolic Events in Patients with Coronavirus Disease 2019 Requiring Hospitalization: an Observational Retrospective Study by the COVIDIC Initiative in a Swiss University Hospital

“…The importance of these clinical incidence rates is further highlighted by a recent series of 12 consecutive autopsy reports showing the presence of VTE in 58% of cases, who went unrecognized before death [ 32 ]. Among patients hospitalized in wards, the incidence of VTE (5.9%; 20 out of 335 patients) was also inferior to the one reported in the abovementioned meta-analysis (13%) [ 25 , 26 ]. These lower rates in our study could be explained by the intensification of prophylactic anticoagulation during the study period, as well as the earlier hospitalization of many patients presenting less severe complications compared to other countries with a more significant healthcare overload [ 14 ].…”

“…Finally, in the third period, despite the high number of ceCT scans performed, a trend towards fewer VTE diagnoses was observed during hospitalization. This pattern could reflect the effect of more aggressive anticoagulation strategies implemented in ICU-hospitalized patients on April 6, 2020 [ 25 ].…”

“…A patient was considered to be on anticoagulation treatment in case of administration of any type of anticoagulation in prophylactic or therapeutic dosage, for more than 72 h before VTE diagnosis. Intermediate-dosage thromboprophylaxis protocol (for creatinineclearance ≥ 30 ml/minUFH sc 5,000 UI tid or enoxaparin 40 mg bid (<120 kg) or 60 mg bid (≥120 kg); for creatinine clearance <30 ml/min UFH iv 200 UI/kg/24 h) was included on April 6, 2020 in the internal recommendations on thromboprophylaxis in COVID-19 patients admitted in the ICU [ 25 ]. Because the level of awareness of VTE complications related to COVID-19 rose rapidly during the pandemic period as a consequence of the accumulation of reports in the literature, the study period was divided into three periods: the first period from February 28 to March 25 (low awareness of SARS-CoV-2 thrombogenic potential), second from March 26 to April 5 (increased level of awareness), and third from April 6 to May 5 (change in prophylactic anticoagulation in ICU patients).…”

Pulmonary Embolism Does Not Have an Unusually High Incidence Among Hospitalized COVID19 Patients

“…[48][49][50][51][52][53][54][55][56][57][58][59][60] Among ten additional studies that reported the numbers of PE among hospitalized COVID19 patients, the combined incidence was 3.8% (268 cases among 7015 subjects). [48][49][50][51][52][53][54][55][56][57] Also similar to our findings, the incidence of PE among studies with at least 400 subjects decreased to 3.0% (174 cases among 5711 subjects). 49,57 Finally, the PE incidence among COVID19 patients admitted to ICUs in the newer studies was 8.0% (87 cases among 1081 COVID19 patients admitted to ICUs), similar to the incidence among the studies we had included.…”

COVID-19 in thrombosis research: An editorial perspective

“…Several potential players have been thought to be involved in the interplay between inflammation and coagulation activation in COVID-19 patients and, consequently, biomarkers of disease have been proposed as markers or predictors of severity [ 57 ]. By somehow encompassing these two aspects and representing an easy-to-monitor parameter, D-dimer emerged as one of the most promising markers to estimate the initial severity of the disease, its dynamic course, and the probability of presenting with venous thromboembolism [ 58 , 59 ]. Indeed, increased D-dimer levels may reflect both coagulation activation and a proinflammatory state with intra-alveolar fibrin deposition [ 56 , 57 , 60 , 61 ].…”