By Hratch Karamanoukian MD FACS RVT RPVI RPhS DABVLM (2009)
In this retrospective cohort study (see reference below), hospitalized patients with confirmed Covid-19 infections that were not in intensive care unitswere studied.
Mathieu Artifoni MD and colleagues state that the objective of thier study was to determine incidence and risk factors of venous thromboembolism (VTE) in COVID-19 inpatients receiving thromboprophylaxis.
As such, they performed lower extremity Dopler ultrasonography (Duplex scanning) at hospital discharge or earlier if deep venous thrombosis (DVT) was suspected clinically. CT angiography of the chest scan was performed when pulmonary embolism (PE) was suspected.
The research was conducted at the Service de Médecine Interne, CHU de Nantes, 44093, Nantes, France; Service de Médecine Polyvalente, CH de Châteaubriant, 44110, Châteaubriant, France; Service de Maladies Infectieuses et Tropicales, CHU de Nantes, 44093, Nantes, France; CIC UIC 1413 INSERM, CHU de Nantes, 44093, Nantes, France; Faculté de Médecine, Université de Nantes, 44093, Nantes, France; Service de Maladies Infectieuses et Tropicales, CHU de Nantes, 44093, Nantes, France and CIC UIC 1413 INSERM, CHU de Nantes, 44093, Nantes, France.
RESULTS:
Despite adequate anticoagulation, 16 of 71 (22.5%) developed VTE and 7/71 (10%) developed pulmonary embolism.
D-dimer levels at baseline were significantly higher in patients with DVT (p < 0.001).
Demographics, comorbidities, disease manifestations, severity score, and other biological parameters, including inflammatory markers, were similar in patients with and without VTE.
The negative predictive value of a baseline D-dimer level < 1.0 µg/ml was 90% for VTE and 98% for PE.
The positive predictive value for VTE was 44% and 67% for D-dimer level ≥ 1.0 µg/ml and ≥ 3 µg/ml, respectively.
The association between D-dimer level and VTE risk increased by taking into account the latest available D-dimer level prior to venous duplex ultrasonography for the patients with monitoring of D-dimer.
The authors concluded that
1) despite thromboprophylaxis, the risk of VTE is high in COVID-19 inpatients (non ICU).
2) Increased D-dimer concentrations of more than 1.0 μg/ml predict the risk of venous thromboembolism.
Reference: Artifoni M, Danic G, Gautier G, Cicquel P, Broutoille D, Raffi F, Neel A, Lecomte R. Systematic assessment of venous thromboembolism in Covid-19 patients receiving thrombophylaxis: incidence and role of D- Dime as predictive factors. J Thromb Thrombolysis 2020; 50(1): 211-216.