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2020 ; 48
(9
): e805-e808
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gab.com Text
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Incidence of Venous Thromboembolism in Critically Ill Coronavirus Disease 2019
Patients Receiving Prophylactic Anticoagulation
#MMPMID32618699
Trigonis RA
; Holt DB
; Yuan R
; Siddiqui AA
; Craft MK
; Khan BA
; Kapoor R
; Rahman O
Crit Care Med
2020[Sep]; 48
(9
): e805-e808
PMID32618699
show ga
OBJECTIVES: One of the defining features of the novel coronavirus disease 2019
infection has been high rates of venous thromboses. The present study aimed to
describe the prevalence of venous thromboembolism in critically ill patients
receiving different regimens of prophylactic anticoagulation. DESIGN:
Single-center retrospective review using data from patients with confirmed severe
acute respiratory syndrome coronavirus 2 requiring intubation. SETTING:
Tertiary-care center in Indianapolis, IN, United States. PATIENTS: Patients
hospitalized at international units Health Methodist Hospital with severe acute
respiratory syndrome coronavirus 2 requiring intubation between March 23, 2020,
and April 8, 2020, who underwent ultrasound evaluation for venous thrombosis.
INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 45 patients were
included. Nineteen of 45 patients (42.2%) were found to have deep venous
thrombosis. Patients found to have deep venous thrombosis had no difference in
time to intubation (p = 0.97) but underwent ultrasound earlier in their hospital
course (p = 0.02). Sequential Organ Failure Assessment scores were similar
between the groups on day of intubation and day of ultrasound (p = 0.44 and p =
0.07, respectively). D-dimers were markedly higher in patients with deep venous
thrombosis, both for maximum value and value on day of ultrasound (p < 0.01 for
both). Choice of prophylactic regimen was not related to presence of deep venous
thrombosis (p = 0.35). Ultrasound evaluation is recommended if D-dimer is greater
than 2,000 ng/mL (sensitivity 95%, specificity 46%) and empiric anticoagulation
considered if D-dimer is greater than 5,500 ng/mL (sensitivity 53%, specificity
88%). CONCLUSIONS: Deep venous thrombosis is very common in critically ill
patients with coronavirus disease 2019. There was no difference in incidence of
deep venous thrombosis among different pharmacologic prophylaxis regimens,
although our analysis is limited by small sample size. D-dimer values are
elevated in the majority of these patients, but there may be thresholds at which
screening ultrasound or even empiric systemic anticoagulation is indicated.