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Systematic testing for venous thromboembolism in hospitalized patients with COVID-19 and raised D-dimer levels
Ido Weinberg1, Carmen Fernández-Capitán2, Manuel Quintana-Díaz3
1Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA.
Insights
Hospitalized COVID-19 patients with D-dimer levels over 20 times the normal range face a significantly higher risk of venous thromboembolism (VTE). This finding aids in identifying patients who may benefit from increased anticoagulant prophylaxis doses.
Area of Science:
- Medical Research
- Cardiology
- Infectious Diseases
Background:
- Hospitalized patients with COVID-19 often exhibit elevated D-dimer levels, a known indicator of increased risk for venous thromboembolism (VTE).
- Venous thromboembolism (VTE), encompassing pulmonary embolism (PE) and deep vein thrombosis (DVT), poses a significant threat to hospitalized COVID-19 patients.
Purpose of the Study:
- To identify specific risk factors for VTE in hospitalized COVID-19 patients with elevated D-dimer levels.
- To determine if certain D-dimer level thresholds or other clinical parameters can predict VTE risk.
Main Methods:
- A cohort of 1,306 hospitalized COVID-19 patients with elevated D-dimer levels were tested for PE or DVT across 12 centers between March 25 and July 5, 2020.
- Multivariable analysis was employed to identify independent predictors of VTE, including D-dimer levels and platelet counts.
Main Results:
- Pulmonary embolism (PE) was diagnosed in 24% of patients, and deep vein thrombosis (DVT) in 20%.
- Patients with D-dimer levels exceeding 20 times the upper normal range had a 3.24-fold increased risk of VTE (OR: 3.24; 95%CI: 2.18-4.83).
- A platelet count below 100,000/microL was also associated with a significantly higher VTE risk (OR: 4.17; 95%CI: 1.72-10.0).
Conclusions:
- Hospitalized COVID-19 patients with D-dimer levels more than 20 times the upper normal limit are at a substantially increased risk for VTE.
- These findings suggest a potential benefit for higher-than-recommended doses of anticoagulants for VTE prophylaxis in this high-risk subgroup.
Background:
Hospitalized patients with COVID-19 and raised D-dimer levels have high rates of venous thromboembolism (VTE).
Methods:
We used data from hospitalized patients with COVID-19 that were tested for pulmonary embolism (PE) or deep vein thrombosis (DVT) because of raised D-dimer levels. We aimed to identify patients at increased risk for VTE.
Results:
From March 25 to July 5th, 2020, 1,306 hospitalized patients with COVID-19 and raised D-dimer levels underwent testing for VTE in 12 centers. In all, 171 of 714 (24%) had PE, and 161 of 810 (20%) had DVT. The median time elapsed from admission to VTE testing was 12 days, and the median time from D-dimer measurement to testing 2 days. Most patients with VTE were men (62%), mean age was 62 ± 15 years, 45% were in an intensive care unit. Overall, 681 patients (52%) received VTE prophylaxis with standard doses, 241 (18%) with intermediate doses and 100 (7.7%) with therapeutic doses of anticoagulants. On multivariable analysis, patients with D-dimer levels >20 times the upper normal range (19% of the whole cohort) were at increased risk for VTE (odds ratio [OR]: 3.24; 95%CI: 2.18-4.83), as were those with a platelet count <100,000/microL (OR: 4.17; 95%CI: 1.72-10.0).
Conclusions:
Hospitalized patients with COVID-19 and D-dimer levels >20 times the upper normal range were at an increased risk for VTE. This may help to identify what patients could likely benefit from the use of higher than recommended doses of anticoagulants for VTE prophylaxis.
