Li Zhang1,2, Xiaokai Feng3, Danqing Zhang1,2, Chunguo Jiang3, Heng Mei4, Jing Wang1,2, Cuihong Zhang1,2, Hong Li1,2, Xiaoling Xia1,2, Shuangshuang Kong1,2, Jia Liao1,2, Huijun Jia1,2, Xueqin Pang1,2, Yue Song1,2, Ying Tian1,2, Bin Wang1,2, Chun Wu1,2, Hongliang Yuan1,2, Yongxing Zhang1,2, Yuman Li1,2, Wei Sun1,2, Yanting Zhang1,2, Shuangshuang Zhu1,2, Shuyuan Wang1,2, Yuji Xie1,2, Shuping Ge5, Liming Zhang3, Yu Hu4, Mingxing Xie1,2. 1. Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Li Zhang, D.Z., J.W., C.Z., H.L., X.X., S.K., J.L., H.J., X.P., Y.S., Y.T., B.W., C.W., H.Y., Yongxing Zhang, Y.L., W.S., Yanting Zhang, S.Z., S.W., Y.X., M.X.). 2. Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China (Li Zhang, D.Z., J.W., C.Z., H.L., X.X., S.K., J.L., H.J., X.P., Y.S., Y.T., B.W., C.W., H.Y., Yongxing Zhang, Y.L., W.S., Yanting Zhang, S.Z., S.W., Y.X., M.X). 3. Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, China (X.F., C.J., Liming Zhang). 4. Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (H.M., Y.H.). 5. Department of Pediatrics, St Christopher's Hospital for Children, Tower Health and Drexel University, Philadelphia, PA (S.G.).
Abstract
BACKGROUND: To investigate deep vein thrombosis (DVT) in hospitalized patients with coronavirus disease 2019 (COVID-19), we performed a single institutional study to evaluate its prevalence, risk factors, prognosis, and potential thromboprophylaxis strategies in a large referral and treatment center. METHODS: We studied a total of 143 patients with COVID-19 from January 29, 2020 to February 29, 2020. Demographic and clinical data, laboratory data, including ultrasound scans of the lower extremities, and outcome variables were obtained, and comparisons were made between groups with and without DVT. RESULTS: Of the 143 patients hospitalized with COVID-19 (age 63±14 years, 74 [51.7%] men), 66 patients developed lower extremity DVT (46.1%: 23 [34.8%] with proximal DVT and 43 [65.2%] with distal DVT). Compared with patients who did not have DVT, patients with DVT were older and had a lower oxygenation index, a higher rate of cardiac injury, and worse prognosis, including an increased proportion of deaths (23 [34.8%] versus 9 [11.7%]; P=0.001) and a decreased proportion of patients discharged (32 [48.5%] versus 60 [77.9%]; P<0.001). Multivariant analysis showed an association only between CURB-65 (confusion status, urea, respiratory rate, and blood pressure) score 3 to 5 (odds ratio, 6.122; P=0.031), Padua prediction score ≥4 (odds ratio, 4.016; P=0.04), D-dimer >1.0 μg/mL (odds ratio, 5.818; P<0.014), and DVT in this cohort, respectively. The combination of a CURB-65 score 3 to 5, a Padua prediction score ≥4, and D-dimer >1.0 μg/mL has a sensitivity of 88.52% and a specificity of 61.43% for screening for DVT. In the subgroup of patients with a Padua prediction score ≥4 and whose ultrasound scans were performed >72 hours after admission, DVT was present in 18 (34.0%) patients in the subgroup receiving venous thromboembolism prophylaxis versus 35 (66.0%) patients in the nonprophylaxis group (P=0.010). CONCLUSIONS: The prevalence of DVT is high and is associated with adverse outcomes in hospitalized patients with COVID-19. Prophylaxis for venous thromboembolism may be protective in patients with a Padua protection score ≥4 after admission. Our data seem to suggest that COVID-19 is probably an additional risk factor for DVT in hospitalized patients.
BACKGROUND: To investigate deep vein thrombosis (DVT) in hospitalized patients with coronavirus disease 2019 (COVID-19), we performed a single institutional study to evaluate its prevalence, risk factors, prognosis, and potential thromboprophylaxis strategies in a large referral and treatment center. METHODS: We studied a total of 143 patients with COVID-19 from January 29, 2020 to February 29, 2020. Demographic and clinical data, laboratory data, including ultrasound scans of the lower extremities, and outcome variables were obtained, and comparisons were made between groups with and without DVT. RESULTS: Of the 143 patients hospitalized with COVID-19 (age 63±14 years, 74 [51.7%] men), 66 patients developed lower extremity DVT (46.1%: 23 [34.8%] with proximal DVT and 43 [65.2%] with distal DVT). Compared with patients who did not have DVT, patients with DVT were older and had a lower oxygenation index, a higher rate of cardiac injury, and worse prognosis, including an increased proportion of deaths (23 [34.8%] versus 9 [11.7%]; P=0.001) and a decreased proportion of patients discharged (32 [48.5%] versus 60 [77.9%]; P<0.001). Multivariant analysis showed an association only between CURB-65 (confusion status, urea, respiratory rate, and blood pressure) score 3 to 5 (odds ratio, 6.122; P=0.031), Padua prediction score ≥4 (odds ratio, 4.016; P=0.04), D-dimer >1.0 μg/mL (odds ratio, 5.818; P<0.014), and DVT in this cohort, respectively. The combination of a CURB-65 score 3 to 5, a Padua prediction score ≥4, and D-dimer >1.0 μg/mL has a sensitivity of 88.52% and a specificity of 61.43% for screening for DVT. In the subgroup of patients with a Padua prediction score ≥4 and whose ultrasound scans were performed >72 hours after admission, DVT was present in 18 (34.0%) patients in the subgroup receiving venous thromboembolism prophylaxis versus 35 (66.0%) patients in the nonprophylaxis group (P=0.010). CONCLUSIONS: The prevalence of DVT is high and is associated with adverse outcomes in hospitalized patients with COVID-19. Prophylaxis for venous thromboembolism may be protective in patients with a Padua protection score ≥4 after admission. Our data seem to suggest that COVID-19 is probably an additional risk factor for DVT in hospitalized patients.
Authors: Alexander E Merkler; Neal S Parikh; Saad Mir; Ajay Gupta; Hooman Kamel; Eaton Lin; Joshua Lantos; Edward J Schenck; Parag Goyal; Samuel S Bruce; Joshua Kahan; Kelsey N Lansdale; Natalie M LeMoss; Santosh B Murthy; Philip E Stieg; Matthew E Fink; Costantino Iadecola; Alan Z Segal; Marika Cusick; Thomas R Campion; Ivan Diaz; Cenai Zhang; Babak B Navi Journal: JAMA Neurol Date: 2020-07-02 Impact factor: 18.302
Authors: Mark M G Mulder; LIoyd Brandts; Renée A G Brüggemann; Marcel Koelmann; Alexander S Streng; Renske H Olie; Hester A Gietema; Henri M H Spronk; Iwan C C van der Horst; Jan-Willem E M Sels; Joachim E Wildberger; Sander M J van Kuijk; Ronny M Schnabel; Hugo Ten Cate; Yvonne M C Henskens; Bas C T van Bussel Journal: Thromb J Date: 2021-05-31
Authors: Julie Goswami; Taleen A MacArthur; Meera Sridharan; Rajiv K Pruthi; Robert D McBane; Thomas E Witzig; Myung S Park Journal: Shock Date: 2021-06-01 Impact factor: 3.533
Authors: Y Fares; Y C Sinzogan-Eyoum; P Billoir; A Bogaert; G Armengol; K Alexandre; J Lammens; M Grall; H Levesque; Y Benhamou; S Miranda Journal: J Med Vasc Date: 2021-05-14
Authors: Abby C Lee; Grant Castaneda; Wei Tse Li; Chengyu Chen; Neil Shende; Jaideep Chakladar; Pam R Taub; Eric Y Chang; Weg M Ongkeko Journal: Viruses Date: 2021-05-28 Impact factor: 5.048