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Observational Study
. 2020 Aug:192:23-26.
doi: 10.1016/j.thromres.2020.05.018. Epub 2020 May 13.

Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels

P Demelo-Rodríguez  1 , E Cervilla-Muñoz  2 , L Ordieres-Ortega  2 , A Parra-Virto  2 , M Toledano-Macías  2 , N Toledo-Samaniego  2 , A García-García  2 , I García-Fernández-Bravo  2 , Z Ji  3 , J de-Miguel-Diez  4 , L A Álvarez-Sala-Walther  5 , J Del-Toro-Cervera  1 , F Galeano-Valle  6
Affiliations
Observational Study

Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels

P Demelo-Rodríguez et al. Thromb Res. 2020 Aug.

Abstract

Aim: An increased risk of venous thromboembolism (VTE) in patients with COVID-19 pneumonia admitted to intensive care unit (ICU) has been reported. Whether COVID-19 increases the risk of VTE in non-ICU wards remains unknown. We aimed to evaluate the burden of asymptomatic deep vein thrombosis (DVT) in COVID-19 patients with elevated D-dimer levels.

Method: In this prospective study consecutive patients hospitalized in non-intensive care units with diagnosis of COVID-19 pneumonia and D-dimer > 1000 ng/ml were screened for asymptomatic DVT with complete compression doppler ultrasound (CCUS). The study was approved by the Institutional Ethics Committee.

Results: The study comprised 156 patients (65.4% male). All but three patients received standard doses of thromboprophylaxis. Median days of hospitalization until CCUS was 9 (IQR 5-17). CCUS was positive for DVT in 23 patients (14.7%), of whom only one was proximal DVT. Seven patients (4.5%) had bilateral distal DVT. Patients with DVT had higher median D-dimer levels: 4527 (IQR 1925-9144) ng/ml vs 2050 (IQR 1428-3235) ng/ml; p < 0.001. D-dimer levels > 1570 ng/ml were associated with asymptomatic DVT (OR 9.1; CI 95% 1.1-70.1). D-dimer showed an acceptable discriminative capacity (area under the ROC curve 0.72, 95% CI 0.61-0.84).

Conclusion: In patients admitted with COVID-19 pneumonia and elevated D-dimer levels, the incidence of asymptomatic DVT is similar to that described in other series. Higher cut-off levels for D-dimer might be necessary for the diagnosis of DVT in COVID-19 patients.

Keywords: COVID-19; D-dimer; Deep vein thrombosis; Doppler ultrasound; SARS-CoV-2 infection; Venous thromboembolism.

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Figures

Fig. 1
Fig. 1
Area under ROC curve for D-dimer in DVT diagnosis. (AUC: Area under ROC curve; ROC: receiver operating characteristic; DVT: deep vein thrombosis).
See this image and copyright information in PMC

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