Tutto Interventistica

La trombosi venosa profonda nei pazienti Covid 19


Early detection of deep vein thrombosis in patients with coronavirus disease 2019: who to screen and who not to with Doppler ultrasound?

Anna Maria Ierardi1 · Andrea Coppola2 · Stefano Fusco1 · Elvira Stellato1 · Stefano Aliberti3,7 · Maria Carmela Andrisani1 · Valentina Vespro1 · Antonio Arrichiello1 · Mauro Panigada4 · Valter Monzani5 · Giacomo Grasselli4,7 · Massimo Venturini2 · Bhavya Rehani8 · Flora Peyvandi6,7 · Antonio Pesenti4,7 · Francesco Blasi3,7 · Gianpaolo Carrafello1,9 Received: 20 June 2020 / Accepted: 21 July 2020 © Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2020

Abstract

Purpose

Aim of the study is to evaluate the incidence of DVT in COVID-19 patients and its correlation with the severity of the disease and with clinical and laboratory findings.

Methods

234 symptomatic patients with COVID-19, diagnosed according to the World Health Organization guidelines, were included in the study. The severity of the disease was classified as moderate, severe and critical. Doppler ultrasound (DUS) was performed in all patients. DUS findings, clinical, laboratory’s and therapeutic variables were investigated by contingency tables, Pearson chi square test and by Student t test and Fisher’s exact test. ROC curve analysis was applied to study significant continuous variables.

Results

Overall incidence of DVT was 10.7% (25/234): 1.6% (1/60) among moderate cases, 13.8% (24/174) in severely and critically ill patients. Prolonged bedrest and intensive care unit admission were significantly associated with the presence of DVT (19.7%). Fraction of inspired oxygen, P/F ratio, respiratory rate, heparin administration, D-dimer, IL-6, ferritin and CRP showed correlation with DVT.

Conclusion

DUS may be considered a useful and valid tool for early identification of DVT. In less severely affected patients, DUS as screening of DVT might be unnecessary. High rate of DVT found in severe patients and its correlation with respiratory parameters and some significant laboratory findings suggests that these can be used as a screening tool for patients who should be getting DUS.

Introduction

Deep vein thrombosis (DVT) occurred in 3.5% of intensive care unit (ICU) patients and 1.3% in hospitalized patient in medicine wards [1, 2].

A hallmark of patients affected by coronavirus disease 2019 (COVID-19) is coagulopathy.

Mechanism and pathogenesis is still not clear, although excessive inflammation, hypoxia, immobilization and diffuse intravascular coagulation could be possible factors associated with high incidence of thromboembolism [3, 4].

Clinical observations stemming from patients admitted to intensive care units (ICU) showed that several patients have signs of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE) [5, 6].

The purpose of this study was to explore the incidence of DVT in COVID-19 patients and correlate it with the severity of the disease as well as with clinical and laboratory findings.



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