Table 3.
Incidence of VTE in Patients with COVID‐19
| Patients | Evaluation methods | Prophylaxis | Thrombosis rates | Comments |
|---|---|---|---|---|
| 81 ICU patients29 | Screened with CUS | None | 25% (n = 20) DVT |
Patients with VTE where older, had lower lymphocyte counts, longer aPTT, and higher D‐dimer level Suggest using D‐dimer of >1500 ng/ml as predictor of VTE |
| 143 hospitalized patients30 | Screened with CUS | 37.1% received LMWH prophylaxis |
46.1% (n = 66) DVT 16.1% (n = 23) proximal DVT 30.0% (n = 43) distal DVT |
Patients with DVT had higher D‐dimer (6600 vs 900 ng/ml; p < 0.001) |
| 48 ICU patients31 | Screened with CUS | Enoxaparin 30‐40 mg QD |
85% (n = 41) DVT 10% (n = 5) proximal DVT 75% (n = 36) distal DVT |
Median D‐dimer level (p = 0.09) No DVT = 900 ng/ml Distal DVT = 5310 ng/ml Proximal DVT = 3530 ng/ml |
| 26 ICU patients32 | Screened with CUS | LMWH or UFH prophylaxis in 31% and therapeutic doses in 69% |
69% (n=18) DVT 23% (n = 6) PE |
VTE occurred more often in patients receiving prophylactic vs therapeutic anticoagulation (100% vs 56%; p = 0.03). All PE occurred with therapeutic doses. |
| 45 ICU patients on ventilator33 | Screened with CUS | Enoxaparin 40 mg QD (16%), 30 mg BID (35%), 40 mg BID (13%), UFH (26%), and other (9%) | 42% (n = 19) DVT |
Patients with DVT had higher D‐dimer (6911 vs 3148 ng/ml; p < 0.01) No differences between prophylaxis regimens (p = 0.35), but numbers too small to make comparisons |
| 184 ICU patients34 | Clinical suspicion evaluation | Nadroparin 2850 IU QD and 5700 IU QD if >100 kg, or 5700 IU QD and BID if >100 kg |
31% (n = 57) thrombosis 27% (n = 50) VTE 3.8% (n = 7) arterial |
81% of VTE were PE (n = 25) Predictors of thrombosis were age, prolonged PT > 3 sec, or aPTT > 5 sec |
| 75 ICU patients35 | Clinical suspicion evaluation | LMWH or UFH |
33.3% (n = 25) thrombosis 26.7% (n = 20) PE 4.0% (n = 3) DVT 2.7% (n = 2) ischemic stroke |
|
| 109 ICU patients36 | Clinical suspicion evaluation | 56% UFH 5000 IU TID, 24% enoxaparin 40 mg QD, or 13% enoxaparin 30 mg BID. 6% received therapeutic anticoagulation | 28% (n = 31) VTE | Patients with VTE had higher D‐dimer (4046 vs 1934 ng/ml; p < 0.001) |
| 91 ICU patients37 | Clinical suspicion evaluation | LMWH or UFH prophylaxis in 46% and therapeutic doses in 54% |
26% (n = 24) VTE 5.5% (n = 5) lower‐extremity DVT 6.6% (n = 6) upper‐extremity DVT 8.8% (n = 8) jugular thrombosis 5.5% (n = 5) PE |
Patients with VTE had more days on the ventilator (15 vs 11 days; p = 0.02) and longer length of stay (26 vs 16 days; p = 0.001) 73% of patients requiring ECMO developed VTE |
| 156 ward patients38 | Screened with CUS if D‐dimer> 1000 ng/ml | 98% received LMWH |
14.7% (n = 23) DVT 0.6% (n = 1) proximal DVT 14.1% (n = 22) distal DVT 4.5% (n = 7) bilateral DVT |
Patients with DVT had higher D‐dimer (4527 vs 2050 ng/ml) |
| 84 ward patients39 | Screened with CUS | 97.6% received enoxaparin 40 mg QD and 2.4% received fondaparinux 2.5 mg QD |
11.9% (n = 10) DVT 2.4% (n = 2) proximal DVT 9.5% (n = 8) distal DVT 4.7% (n = 4) bilateral DVT |
Mean PADUA score of 5.1 Patients with DVT were more likely to have a D‐dimer > 3000 ng/ml (60% vs 23%; p < 0.05) |
| 82 patients = 52 ward patients and 30 ICU patients40 | Clinical suspicion evaluation |
Enoxaparin 40 mg QD or 60 QD if >100 kg in ward patients. Enoxaparin 40 mg BID or 60 mg BID if > 100 kg in ICU patients |
7.3 % (n = 6) VTE |
Rate of VTE was higher in ICU patients (13% vs 4%) All patients with VTE in the ICU were on mechanical ventilation |
| 198 patients = 123 ward patients and 75 ICU patients41 | Screening with CUS |
84% nadroparin 2850 IU QD and 5700 QD if >100 kg and ICU patients BID 9.6% therapeutic AC |
20% (n = 39) VTE 13% (n = 25) symptomatic VTE 6.6% (n = 13) PE 7.1% (n = 14) proximal DVT 5.6% (n = 11) distal DVT 0.5% (n = 1) upper extremity |
13% COVID‐19 diagnosis not confirmed. D‐dimer higher in ICU patients (2000 vs 1100 mg/ml; p = 0.006) VTE higher in ICU patients (47% vs 3.3%; HR 7.9, 95% CI 2.8 – 23) Symptomatic VTE higher in ICU patients (28% vs 3.3%; HR 3.9, 95% CI 1.3 – 12) |
| 30 ward patients with COVID‐19 and 24 ward patients in 201942 | All received CUS for clinical suspicion | Not mentioned |
53% (n = 16) DVT in COVID‐19 patients 20.8% (n = 5) DVT in 2019 |
|
| 303 patients = 107 with COVID‐19 and 196 during same time in 2019 (40 with influenza)43 | Clinical suspicion evaluation | All patients received guideline appropriate thromboprophylaxis |
Higher PE rate in COVID‐19 patients compared to 2019 (20.7% vs 6.1%). Higher PE rate in COVID‐19 patients compared to 2019 influenza (20.7% vs 7.5%) |
91% of COVID‐19 patients with PE received some type of anticoagulation prior to diagnosis Report “low number of associated DVT” but number not provided. |
| 222 matched patients = 77 ICU COVID‐19 ARDS patients and 145 non‐COVID‐19 ARDS patients from 2014‐201944 | Clinical suspicion evaluation |
LMWH or UFH COVID‐19 patients 78% prophylaxis 22% treatment dose Non‐COVID‐19 patients 76% prophylaxis 24% treatment dose |
COVID‐19 vs non‐COVID‐19 Thrombotic events (11.7% vs 4.8%; p = 0.04) PE (11.7 vs 2.1%; p = 0.01) DVT (0% vs 2%; p = NS) |
aPTT = activated partial thromboplastin time; ARDS = acute respiratory distress syndrome. AC = anticoagulation; BID = twice daily; COVID‐19 = coronavirus 2019 infection; CUS = compression ultrasound; DVT = deep vein thrombosis; ECMO = extracorporeal membrane oxygenation; ICU = intensive care unit; LMWH = low molecular weight heparin; PE = pulmonary embolism; PT = prothrombin time; QD = once daily; TID = three times daily; UFH = unfractionated heparin; VTE = venous thromboembolism.