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25.08.2020 | COVID-19 | IM - ORIGINAL Zur Zeit gratis

Prevalence of asymptomatic deep vein thrombosis in patients hospitalized with SARS-CoV-2 pneumonia: a cross-sectional study

verfasst von: Matteo Giorgi-Pierfranceschi, Oriana Paoletti, Angelo Pan, Fabio De Gennaro, Anna Laura Nardecchia, Rossella Morandini, Claudia Dellanoce, Samuele Lombi, Maurizio Tala, Vanessa Cancelli, Silvia Zambelli, Giancarlo Bosio, Laura Romanini, Sophie Testa

Erschienen in: Internal and Emergency Medicine | Ausgabe 8/2020

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Abstract

The association between coronavirus disease 2019 (COVID-19) pneumonia and venous thrombotic disorders is still unclear. We assessed the association between COVID-19 infection-related pneumonia and proximal deep-vein thrombosis (DVT) in a cohort of patients admitted to our hospital during the European outbreak in the front line of Cremona, Lombardy. In a single-center cross-sectional study, all patients hospitalized for more than 5 days in Internal Medicine Department with confirmed COVID-19 pneumonia received 2-point compressive ultrasound assessment (CUS) of the leg vein system during a single day. Ninety-four percent of patients received enoxaparin as standard pharmacological prophylaxis for venous thromboembolism. The presence of DVT was defined as incompressibility of popliteal or common femoral vein. Out of 121 patients with COVID-19 pneumonia (mean age 71.8, 66.3% males) hospitalized on March 31st, 70 stayed in hospital for over 5 days and 66 of them underwent CUS of deep venous system of the legs. The presence of asymptomatic DVT was found in 9 patients (13.6%). No symptomatic DVT was found. Patients with DVT showed mean age = 75.7 years, mean D-dimer levels = 4.02 ng/ml and all of them received enoxaparin for thromboprophylaxis, except one. Computed tomography pulmonary angiogram confirmed pulmonary embolism in five patients. One every seven patients with COVID-19-related pneumonia, hospitalized for more than 5 days, had asymptomatic proximal DVT and half of them had confirmed PE despite standard pharmacological thromboprophylaxis. This observational study suggests the need of an active surveillance through CUS in patients hospitalized with acute SARS-COV-2 and underline the need of a more intense thromboprophylaxis.

Phelan AL, Katz R, Gostin LO (2020) The novel coronavirus originating in Wuhan, China: Challenges for Global Health Governance. JAMA. https://doi.org/10.1001/jama.2020.1097CrossRef

World Health Organization (WHO) (2020) Coronavirus disease 2019 (COVID-19) Situation Report – 51, 2020

Heit JA, Melton LJ, Lohse CM et al (2001) Incidence of venous thromboembolism in hospitalized patients vs community residents. Mayo Clin Proc 76(11):1102–1110CrossRef

Bahl V et al (2010) A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg 251:344–350CrossRef

Cohen AT, Alikhan R, Arcelus JI, Bergmann JF, Haas S, Merli GJ, Spyropoulos AC, Tapson VF, Turpie AG (2005) Assessment of venous thromboembolism risk and the benefits of thromboprophylaxis in medical patients. Thromb Haemost 94(4):750–759

Alikhan R, Cohen AT, Combe S, Samama MM, Desjardins L, Eldor A, Janbon C, Leizorovicz A, Olsson CG, Turpie AG, MEDENOX Study (2004) Risk factors for venous thromboembolism in hospitalized patients with acute medical illness: analysis of the MEDENOX Study. Arch Intern Med 164(9):963–968CrossRef

Dentali F, Douketis JD, Gianni M, Lim W, Crowther MA (2007) Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Ann Intern Med 146(4):278–288CrossRef

Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA, Cook DJ, Balekian AA, Klein RC, Le H, Schulman S, Murad MH (2012) Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e195S–e226SCrossRef

Schünemann HJ, Cushman M, Burnett AE, Kahn SR, Beyer-Westendorf J, Spencer FA, Rezende SM, Zakai NA, Bauer KA, Dentali F, Lansing J, Balduzzi S, Darzi A, Morgano GP, Neumann I, Nieuwlaat R, Yepes-Nuñez JJ, Zhang Y, Wiercioch W (2018) American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and non-hospitalized medical patients. Blood Adv 2(22):3198–3225CrossRef

10.

Samama MM, Cohen AT, Darmon JY, Desjardins L, Eldor A, Janbon C, Leizorovicz A, Nguyen H, Olsson CG, Turpie AG, Weisslinger N (1999) A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group. N Engl J Med 341(11):793–800CrossRef

11.

Leizorovicz A, Cohen AT, Turpie AG, Olsson CG, Vaitkus PT, Goldhaber SZ, PREVENT Medical Thromboprophylaxis Study Group (2004) Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation 110(7):874–879CrossRef

12.

Cohen AT, Davidson BL, Gallus AS, Lassen MR, Prins MH, Tomkowski W, Turpie AG, Egberts JF, Lensing AW, Investigators ARTEMIS (2006) Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomized placebo-controlled trial. BMJ 332(7537):325–329CrossRef

13.

Mahan CE, Pini M, Spyropoulos AC (2010) Venous thromboembolism prophylaxis with unfractionated heparin in the hospitalized medical patient: the case for thrice daily over twice daily dosing. Intern Emerg Med 5:299–306CrossRef

14.

Amin AN, Varker H, Princic N, Lin J, Thompson S, Johnston S (2012) Duration of venous thromboembolism risk across a continuum in medically ill hospitalized patients. J Hosp Med 7(3):231–238CrossRef

15.

Vandiver JW, Ritz LI, Lalama JT (2016) Chemical prophylaxis to prevent venous thromboembolism in morbid obesity: literature review and dosing recommendations. J Thromb Thrombolysis 41(3):475–481CrossRef

16.

Boonyawat K, Crowther MA (2015) Venous thromboembolism prophylaxis in critically ill patients. Semin Thromb Hemost 41(1):68–74CrossRef

17.

Minet C, Potton L, Bonadona A, Hamidfar-Roy R, Somohano CA, Lugosi M, Cartier JC, Ferretti G, Schwebel C, Timsit JF (2015) Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis. Crit Care 19:287CrossRef

18.

Kaplan D, Casper TC, Elliott CG, Men S, Pendleton RC, Kraiss LW, Weyrich AS, Grissom CK, Zimmerman GA, Rondina MT (2015) VTE incidence and risk factors in patients with severe sepsis and septic shock. Chest 148(5):1224–1230CrossRef

19.

Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M, De Bon E, Tormene D, Pagnan A, Prandoni P (2010) A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost 8(11):2450–2457CrossRef

20.

Barbar S, Prandoni P (2017) Scoring systems for estimating risk of venous thromboembolism in hospitalized medical patients. Semin Thromb Hemost 43(5):460–468CrossRef

21.

Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases Interim guidance, 19 March 2020. Publication WHO REFERENCE NUMBER: WHO/COVID-19/laboratory/2020.5. https://www.who.int/publications-detail/laboratory-testing-for-2019-novel-coronavirus-in-suspected-human-cases-20200117

22.

Needleman L, Cronan JJ, Lilly MP, Merli GJ, Adhikari S, Hertzberg BS, DeJong MR, Meissner MH, Streiff MB (2018) Ultrasound for lower extremity deep venous thrombosis: multidisciplinary recommendations from the society of radiologists in ultrasound consensus conference. Circulation 137(14):1505–1515CrossRef

23.

Lensing AWA, Prandoni P, Brandjes D, Huisman PM, Vigo M, Tomasella G et al (1989) Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med 320:342–345CrossRef

24.

Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, Kaptein FHJ, van Paassen J, Stals MAM, Huisman MV, Endeman H (2020) Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 20(20):30120–30121

25.

Wichmann D, Sperhake JP, Lütgehetmann M, et al. (2020) Autopsy findings and venous thromboembolism in patients with COVID-19 [published online ahead of print, 2020 May 6]. Ann Intern Med, M20-2003

26.

Artifoni M, Danic G, Gautier G et al (2020) Systematic assessment of venous thromboembolism in COVID-19 patients receiving thromboprophylaxis: incidence and role of D-dimer as predictive factors. J Thromb Thrombolysis 50(1):211–216. https://doi.org/10.1007/s11239-020-02146-zCrossRef

27.

Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR (2020) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): the epidemic and the challenges. Int J Antimicrob Agents 55(3):105924CrossRef

28.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lance. 395(10223):497–506CrossRef

29.

Cogo A, Lensing AW, Koopman MM, Piovella F, Siragusa S, Wells PS, Villalta S, Büller HR, Turpie AG, Prandoni P (1998) Compression ultrasonography for diagnostic management of patients with clinically suspected deep vein thrombosis: prospective cohort study. BMJ 316(7124):17–20CrossRef

30.

Vaitkus PT, Leizorovicz A, Cohen AT, Turpie AG, Olsson CG, Goldhaber SZ (2005) Prevent Medical Thromboprophylaxis Study Group, Mortality rates and risk factors for asymptomatic deep vein thrombosis in medical patients. Thromb Haemost 93(1):76–79CrossRef

31.

Zhou Fei, Ting Yu, Ronghui Du, Fan Guohui, Liu Ying, Liu Zhibo, Xiang Jie, Wang Yeming, Song Bin, XiaoyingGu Lulu Guan, Wei Yuan, Li Hui, Xudong Wu, Jiuyang Xu, ShengjinTu Yi Zhang, Chen Hua, Cao Bin (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 395:1054–1062CrossRef

32.

Obi AT, Tignanelli CJ, Jacobs BN, Arya S, Park PK, Wakefield TW, Henke PK, Napolitano LM (2019) Empirical systemic anticoagulation is associated with decreased venous thromboembolism in critically ill influenza A H1N1 acute respiratory distress syndrome patients. J Vasc Surg Venous Lymphat Disord 7(3):317–324CrossRef

33.

Poli D, Tosetto A, Palareti G et al (2020) Managing anticoagulation in the COVID-19 era between lockdown and reopening phases. Intern Emerg Med. https://doi.org/10.1007/s11739-020-02391-3CrossRef

34.

Testa S, Paoletti O, Giorgi-Pierfranceschi M et al (2020) Switch from oral anticoagulants to parenteral heparin in SARS-CoV-2 hospitalized patients. Intern Emerg Med. https://doi.org/10.1007/s11739-020-02331-1CrossRef

35.

Wang T, Chen R, Liu C et al (2020) Attention should be paid to venous thromboembolism prophylaxis in the management of COVID-19. Lancet Haematol. 7(5):e362–e363CrossRef

36.

Johnston A, Hsieh SC, Carrier M, Kelly SE, Bai Z, Skidmore B, Wells GA (2018) A systematic review of clinical practice guidelines on the use of low molecular weight heparin and fondaparinux for the treatment and prevention of venous thromboembolism: implications for research and policy decision-making. PLoS ONE 13(11):e0207410CrossRef

37.

Smythe MA, Priziola J, Dobesh PP, Wirth D, Cuker A, Wittkowsky AK (2016) Guidance for the practical management of the heparin anticoagulants in the treatment of venous thromboembolism. J Thromb Thrombolysis 41(1):165–186CrossRef

38.

Anderson JA, Saenko EL (2002) Heparin resistance. Br J Anaesth 88(4):467–469CrossRef

39.

Girolami A, Cosi E, Ferrari S, Girolami B (2018) Heparin, coumarin, protein C, antithrombin, fibrinolysis and other clotting related resistances: old and new concepts in blood coagulation. J Thromb Thrombolysis 45(1):135–141CrossRef

40.

Manfredini R (2006) D-dimer for the diagnosis of acute venous thromboembolism in the emergency department: a Janus-face marker. Int Emergency Med 1:54CrossRef

41.

Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, Ma K, Xu D, Yu H, Wang H, Wang T, Guo W, Chen J, Ding C, Zhang X, Huang J, Han M, Li S, Luo X, Zhao J, Ning Q (2020) Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ 368:m1091CrossRef

42.

Terpos E, Ntanasis-Stathopoulos I, Elalamy I et al (2020) Hematological findings and complications of COVID-19. Am J Hematol 95(7):834–847CrossRef

43.

Lim W, Le Gal G, Bates SM, Righini M, Haramati LB, Lang E, Kline JA, ChasteenS Snyder M, Patel P, Bhatt M, Patel P, Braun C, Begum H, Wiercioch W, Schünemann HJ, Mustafa RA (2018) American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv. 2(22):3226–3256CrossRef

44.

Linkins LA, Takach Lapner S (2017) Review of D-dimer testing: good, bad, and ugly. Int J Lab Hematol. 39(Suppl 1):98–103CrossRef

45.

Rodger MA, Le Gal G, Wells P, Baglin T, Aujesky D, Righini M, Palareti G, Huisman M, Meyer G (2014) Clinical decision rules and D-Dimer in venous thromboembolism: current controversies and future research priorities. Thromb Res 134(4):763–768CrossRef

46.

Leidi A, Rouyer F, Marti C, Reny JL, Grosgurin O (2020) Point of care ultrasonography from the emergency department to the internal medicine ward: current trends and perspectives. Intern Emerg Med 15(3):395–408. https://doi.org/10.1007/s11739-020-02284-5CrossRef

47.

Adhikari S, Zeger W, Thom C, Fields JM (2015) Isolated deep venous thrombosis: implications for 2-point compression ultrasonography of the lower extremity. Ann Emerg Med 66:262–266. https://doi.org/10.1016/j.annemergmed.2014.10.032CrossRef

48.

Frederick MG, Hertzberg BS, Kliewer MA, Paulson EK, Bowie JD, Lalouche KJ, DeLong DM, Carroll BA (1996) Can the US examination for lower extremity deep venous thrombosis be abbreviated? A prospective study of 755 examinations. Radiology 199:45–47. https://doi.org/10.1148/radiology.199.1.8633171CrossRef

Titel: Prevalence of asymptomatic deep vein thrombosis in patients hospitalized with SARS-CoV-2 pneumonia: a cross-sectional study
verfasst von: Matteo Giorgi-Pierfranceschi
Oriana Paoletti
Angelo Pan
Fabio De Gennaro
Anna Laura Nardecchia
Rossella Morandini
Claudia Dellanoce
Samuele Lombi
Maurizio Tala
Vanessa Cancelli
Silvia Zambelli
Giancarlo Bosio
Laura Romanini
Sophie Testa
Publikationsdatum: 25.08.2020
Verlag: Springer International Publishing
Schlagwörter: COVID-19
Tiefe Beinvenenthrombose
Tiefe Venenthrombose
Thrombose
Diagnostik in der Infektiologie
Diagnostik in der Angiologie
Angiologische Notfallmedizin
Infektionen in der Intensivmedizin
Erschienen in: Internal and Emergency Medicine / Ausgabe 8/2020
Print ISSN: 1828-0447
Elektronische ISSN: 1970-9366
DOI: https://doi.org/10.1007/s11739-020-02472-3

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Bei Immuntherapien das erhöhte Thromboserisiko beachten

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