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Upsurge of deep venous thrombosis in patients affected by COVID-19: Preliminary data and possible explanations

Published:April 16, 2020DOI:https://doi.org/10.1016/j.jvsv.2020.04.004
      It is known that hospitalized, bedridden patients are particularly prone to development of deep venous thrombosis (DVT); in the absence of adequate prophylaxis, its overall incidence among in-hospital patients is 0.9%, rising up to 15% to 32% among intensive care unit (ICU) patients.
      • Bo H.
      • Li Y.
      • Liu G.
      • Ma Y.
      • Li Z.
      • Cao J.
      • et al.
      Assessing the risk for development of deep vein thrombosis among Chinese patients using the 2010 Caprini risk assessment model: a prospective multicenter study [published online ahead of print December 17, 2019].
      ,
      • Cook D.J.
      • Crowther M.A.
      • Meade M.O.
      • Douketis J.
      VTE in the ICU Workshop Participants. Prevalence, incidence, and risk factors for venous thromboembolism in medical-surgical intensive care unit patients.
      However, during the last month, a remarkable increase in the diagnosis of DVT has been noticed among non-ICU hospitalized patients as well due to the numerous cases of DVT observed among patients infected by coronavirus disease 2019 (COVID-19). In the last month, the Unit of Vascular Surgery of the teaching hospital S. Matteo, in Pavia, one of the hub centers for COVID-19 in Lombardy, the Italian region most affected by the pandemic, was requested to perform 30 compression ultrasound scans of the venous system, of both lower and upper limbs, of COVID-19 non-ICU patients with signs or symptoms suggestive of DVT, and 16 of them had positive results; 6 more had no DVT but superficial thrombophlebitis or upper limb lymphedema. The most frequent localization of the thrombus was the iliac-femoral-popliteal axis, followed by the brachial-axillary veins and the calf veins (Table). Four cases developed from a central vein catheter placed in the femoral vein. Although the numbers are too small to perform statistical analysis, the same period in 2019 could provide a term of comparison: in March 2019, the same unit performed 24 compression ultrasound scans on the whole hospital and found only 5 cases of DVT.
      TableBaseline clinical characteristics of COVID-19 patients with deep venous thrombosis (DVT)
      DVT location No. M:F Age, years, mean (range) Main risk factors for DVT
      The main risk factors for DVT are active cancer, surgery or major trauma in the past 12 weeks, known thrombophilia, pregnancy, oral contraception, and intravenous catheters.
      c-PAP bearers
      Femoropopliteal veins 7 3:4 64.3 (57-70) 4 CVC bearers 5/7
      Axillary-brachial veins 5 3:2 69 (65-77) 1 Breast cancer 5/5
      Calf and tibial veins 4 2:2 62.7 (65-71) 0 2/4
      c-PAP, Continuous positive airway pressure; CVC, central vein catheter.
      a The main risk factors for DVT are active cancer, surgery or major trauma in the past 12 weeks, known thrombophilia, pregnancy, oral contraception, and intravenous catheters.
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      References

        • Bo H.
        • Li Y.
        • Liu G.
        • Ma Y.
        • Li Z.
        • Cao J.
        • et al.
        Assessing the risk for development of deep vein thrombosis among Chinese patients using the 2010 Caprini risk assessment model: a prospective multicenter study [published online ahead of print December 17, 2019].
        J Atheroscler Thromb. 2019; (doi: 10.5551/jat.51359)
        • Cook D.J.
        • Crowther M.A.
        • Meade M.O.
        • Douketis J.
        VTE in the ICU Workshop Participants. Prevalence, incidence, and risk factors for venous thromboembolism in medical-surgical intensive care unit patients.
        J Crit Care. 2005; 20: 309-313
        • Obi A.T.
        • Tignanelli C.J.
        • Jacobs B.N.
        • Arya S.
        • Park P.K.
        • Wakefield T.W.
        • et al.
        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. 2019; 7: 317-324
        • Milbrandt E.B.
        • Reade M.C.
        • Lee M.
        • Shook S.L.
        • Angus D.C.
        • Kong L.
        • et al.
        Prevalence and significance of coagulation abnormalities in community-acquired pneumonia.
        Mol Med. 2009; 15: 438-445