Systematic Screening for Deep Vein Thrombosis in Critically Ill Inpatients With COVID-19: Impact on the Incidence of Venous Thromboembolism.

François-Xavier Lapébie,Fanny Vardon-Bounes,Stein Silva,Bertrand Combis,Thomas Geeraerts,Vincent Minville,Arthur Thery,Alessandra Bura-Rivière,Agnès Ribes

doi:10.3389/fmed.2020.624808

Abstract

Background: Several studies suggest an increased incidence of thrombosis in COVID-19 patients. However, evidence on how to prevent and even treat it is scarce. The aim of this study was to compare the cumulative incidence of venous thromboembolism (VTE) of two different methods for lower extremity deep vein thrombosis (LE-DVT) diagnosis: systematic vs. clinically guided complete compression venous ultrasonography (CCUS). We conducted a monocentric, prospective, open-label, non-randomized study. All consecutive patients admitted in three intensive care units (ICUs) of University Hospital of Toulouse for COVID-19 pneumonia were included: one performed systematic screening for LE-DVT, the others did not. The primary outcome was the 21-day cumulative incidence of VTE. The secondary end points were the 21-day cumulative incidences of major bleeding and death.Results: Among the 78 patients included, 27 (34.6%) underwent systematic screening for DVT 7 ± 2 days after ICU admission. Thirty-two patients (41.0%) were diagnosed with VTE, with a 21-day cumulative incidence of 42.3% (95% CI, 31.4–55.2), without difference between screened and non-screened patients (hazard ratio 1.45, 95% CI, 0.72–2.93). In the screened group, the frequency of isolated DVT was higher (25.9 vs. 5.9%, p-value = 0.027), but the frequency of pulmonary embolism was not reduced (25.9 vs. 29.4%, p-value = 0.745). The 21-day cumulative incidences of major bleeding and death were 9.6% (95% CI, 4.7–19.2) and 10.3% (95% CI, 5.0–20.8), respectively, without difference between the two groups.Conclusions: A systematic screening for DVT in patients hospitalized in ICU was not associated with a higher diagnosis of VTE or a reduced diagnosis of PE.

Highlights

Ill patients are at high risk for developing venous thromboembolism (VTE), with a frequency ranging from 5.1 to 15.5% despite the use of low-molecular-weight heparin (LMWH) thromboprophylaxis [1]
The aim of this study was to compare the cumulative incidence of venous thromboembolism (VTE) of two different methods for lower extremity deep vein thrombosis (LE-DVT) diagnosis: systematic vs. clinically guided complete compression venous ultrasonography (CCUS)
Thirty-two patients (41.0%) were diagnosed with VTE, with a 21-day cumulative incidence of 42.3%, without difference between screened and non-screened patients

Summary

Introduction

Ill patients are at high risk for developing venous thromboembolism (VTE), with a frequency ranging from 5.1 to 15.5% despite the use of low-molecular-weight heparin (LMWH) thromboprophylaxis [1]. In a multicentric study of 184 patients hospitalized in intensive care unit (ICU) with COVID19 pneumonia, the adjusted cumulative incidence of thrombotic complication was 49% [95% confidence interval (95% CI), 41– 57], with a majority of pulmonary embolism (PE) [3]. In another monocentric study of 107 ICU patients with COVID-19, the cumulative incidence of PE at 15 days of admission was 20.4% (95% CI, 13.1–28.7), and frequency of PE was twice as high as that of influenza ICU patients admitted the year before [4]. The secondary end points were the 21-day cumulative incidences of major bleeding and death

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Conclusion