Venous Thromboembolism Complicated with COVID-19: What Do We Know So Far?

Abstract

Coronavirus disease (COVID-19) is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is responsible for the ongoing 2019-2020 pandemic. Venous thromboembolism (VTE), a frequent cardiovascular and/or respiratory complication among hospitalized patients, is one of the known sequelae of the illness. Hospitalized COVID-19 patients are often elderly, immobile, and show signs of coagulopathy. Therefore, it is reasonable to assume a high incidence of VTE among these patients. Presently, the incidence of VTE is estimated at around 25% of patients hospitalized in the intensive care unit for COVID-19 even under anticoagulant treatment at prophylactic doses. In this review, we discuss present knowledge of the topic, the unique challenges of diagnosis and treatment of VTE, as well as some of the potential mechanisms of increased risk for VTE during the illness. Understanding the true impact of VTE on patients with COVID-19 will potentially improve our ability to reach a timely diagnosis and initiate proper treatment, mitigating the risk for this susceptible population during a complicated disease.

Understanding the Complex Relationship Between Androgens and SARS-CoV2

“…19 These findings have led some centers to place patients on higher prophylactic doses of anticoagulation to try and prevent sequelae of COVID-related coagulopathy, and is the subject of ongoing clinical trials. 20 TT, particularly when resulting in supratherapeutic levels of testosterone, can induce a coagulopathic state in men, characterized by polycythemia. 21 It is not clear whether TT causes VTE, however the risk of secondary polycythemia (Hct ≥54%) is well-established, and appears to occur at higher rates in certain modalities of TT.…”

Coagulation disorders in SARS-CoV-2 infection

“…But they also have signs of coagulopathy. In addition, the estimated incidence of thrombotic events is not negligible: about a quarter of those infected with the virus and hospitalized in intensive care units are prone to develop thrombosis even under prophylactic anticoagulant treatment 35 . The incidence of venous thromboembolism in patients hospitalized in intensive care units for COVID-19 appears to be higher than in those with other conditions predisposing to thrombotic complications 36 .…”

Prevalence of Pulmonary Embolism in COVID-19: a Pooled Analysis

“…Thus, initial suspicion towards DVT/PE can be gauged from elevated D-dimer levels. With a higher threshold for D-dimer levels of 1.5 μg/ml, the negative predictive value is reported to be 94.7% [ 5 ]. Thus, with elevated D-dimer levels or clinical symptoms, compression ultrasound could be preceded before CT pulmonary angiography since 90% of pulmonary emboli are known to originate from lower extremity DVT [ 5 , 6 ].…”

“…With a higher threshold for D-dimer levels of 1.5 μg/ml, the negative predictive value is reported to be 94.7% [ 5 ]. Thus, with elevated D-dimer levels or clinical symptoms, compression ultrasound could be preceded before CT pulmonary angiography since 90% of pulmonary emboli are known to originate from lower extremity DVT [ 5 , 6 ]. Cardiac investigations such as ECG or TTE should not be heavily relied upon; clinical suspicion should be the most important factor driving the clinician towards suspecting and investigation for PE in COVID-19 patients [ 7 ].…”