J Vasc Surg Venous Lymphat Disord. 2020 Dec 2:S2213-333X(20)30647-8. doi: 10.1016/j.jvsv.2020.11.019. Online ahead of print.
OBJECTIVE: COVID-19 patients may develop coagulopathy which is associated with poor prognosis and high risk of thrombosis. The objective of this work was to evaluate the prevalence of deep venous thrombosis of lower limbs (DVT) through ultrasonography in patients infected with COVID-19 admitted to hospital in conventional units with 5 days monitoring. The secondary objective was to determine if D-dimer levels body mass index (BMI) and C-reactive ; protein (CRP) were associated with DVT.
MATERIALS AND METHODS: 72 patients with a mean age of 65±12.3 years infected with COVID-19 were admitted to three conventional units at our institution ,28 patients were women. A COVID-19 diagnosis was made by transcriptase polymerase chain reaction by means of nasopharyngeal swab or by chest computer tomography (CT) without iodine contrast media. Demographics ,co-morbidities characteristics and laboratory parameters were collected . A preventive anticoagulation treatment was established on admission with low molecular weight heparin (LMWH) . A complete venous duplex ultrasound (DU) test of lower limbs was performed on Day (D) 0 and D5 .A pulmonary CT angiograms with iodine contrast media (CTPA) was required when was ; suspected pulmonary embolism (PE).
RESULTS: On D0 the DU showed acute DVT in seven patients (9.75%).A CTPA was performed in 12 patients (16.65%) ,3 of whom with an acute PE (25 %). On D0 acute DVT was not significantly associated with CRP (mean 101±98.6 in the group without DVT versus 67.6±58.4 mg/l p=0.43) or BMI ( 27.7 ±5.04 versus 28.1 ± 2.65 Kg/m2 p=0.54 ).However we found a significant association between acute DVT and D-dimer levels (1536±2347 versus 9652 ±10205 ng/ml p <0.01).Among the patients included on D0 only 32 had a DU on D5.Forty of them (55.55%) were not examined for the following reasons : 7 were previously diagnosed with VTE on D0 (9.7%) and therefore had been excluded on D5 8 (11%) had been transferred to the intensive care unit (ICU) 10 (14%) discharged from the hospital 5 (7%) died and 10 ( 13.9%) due to technical issues. On D5 5 patients had acute DVT (15.6%) in addition to those found on D0 3 were distal and 2 proximal despite preventive anticoagulation with LMWH.
CONCLUSIONS: Hospitalized non ICU patients with COVID-19 pneumonia have a high frequency of venous thrombotic events justifying screening with duplex ultrasound.