Incidence of Deep Venous Thrombosis in Patients With COVID-19 and Pulmonary Embolism: Compression Ultrasound COVID Study

J Ultrasound Med. 2021 Jul;40(7):1411-1416. doi: 10.1002/jum.15524. Epub 2020 Oct 5.

Abstract

Objectives: Several reports had observed a high risk of pulmonary embolism (PE) in patients with coronavirus disease 2019 (COVID-19), most of them in the intensive care unit. Reported findings indicate that a direct viral-mediated hyperinflammatory response leads to local thromboinflammation. According to those findings, the incidence of deep venous thrombosis (DVT) in patients with COVID-19 and PE should be low. The objective of this study was to evaluate the incidence of DVT in patients with COVID-19 who developed PE.

Methods: In this prospective observational study, consecutive patients hospitalized in the internal medicine ward with a diagnosis of COVID-19 who developed PE were screened for DVT in the lower extremities with complete compression ultrasound.

Results: The study comprised 26 patients. Fifteen patients (57.7%) were male. The median age was 60 years (interquartile range, 54-73 years). Compression ultrasound findings were positive for DVT in 2 patients (7.7%; 95% confidence interval, 3.6%-11.7%). Patients with DVT had central and bilateral PE. In both, venous thromboembolism was diagnosed in the emergency department, so they did not receive previous prophylactic therapy with low-molecular-weight heparin. Patients without DVT had higher median d-dimer levels: 25,688 μg/dL (interquartile range, 80,000-1210 μg/dL) versus 5310 μg/dL (P < .05).

Conclusions: Our study showed a low incidence of DVT in a cohort of patients with COVID-19 and PE. This observation suggests that PE in these patients could be produced mainly by a local thromboinflammatory syndrome induced by severe acute respiratory syndrome coronavirus 2 infection and not by a thromboembolic event.

Keywords: COVID-19; compression ultrasound; coronavirus disease 2019; deep venous thrombosis; pulmonary embolism; thromboinflammatory syndrome.

Publication types

  • Observational Study

MeSH terms

  • COVID-19*
  • Female
  • Humans
  • Incidence
  • Inflammation
  • Male
  • Middle Aged
  • Pulmonary Embolism* / diagnostic imaging
  • Pulmonary Embolism* / epidemiology
  • Risk Factors
  • SARS-CoV-2
  • Thrombosis*
  • Venous Thrombosis* / diagnostic imaging
  • Venous Thrombosis* / epidemiology