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abstract coagulopathy in covid-19 is a burning issue and strategies to prevent thromboembolic events are debated and highly heterogeneous. the objective was to determine incidence and risk factors of venous thromboembolism (vte) in covid-19 inpatients receiving thromboprophylaxis. in this retrospective french cohort study, patients hospitalized in medical wards non-icu with confirmed covid-19 and adequate thromboprophylaxis were included. a systematic low limb venous duplex ultrasonography was performed at hospital discharge or earlier if deep venous thrombosis (dvt) was clinically suspected. chest angio-ct scan was performed when pulmonary embolism (pe) was suspected. of 71 patients, 16 developed vte (22.5%) and 7 pe (10%) despite adequate thromboprophylaxis. d-dimers 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. despite thromboprophylaxis, the risk of vte is high in covid-19 non-icu inpatients. increased d-dimer concentrations of more than 1.0 μg/ml predict the risk of venous thromboembolism. d-dimer level-guided aggressive thromboprophylaxis regimens using higher doses of heparin should be evaluated in prospective studies.
ارزیابی سیستماتیک ترومبوآمبولی وریدی در covid ‑ 19 بیمار دریافت کننده ترومبوپروفیلاکسی: بروز و نقش d-dimer به عنوان عوامل پیش بینی کننده
Last Update: 2020-12-05
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