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Browsing by Subject "Venous Thromboembolism (VTE)"
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Item Routine Venous Thromboembolism Prophylaxis May Be Inadequate in the Hypercoagulable State of Severe Coronavirus Disease 2019(Wolters Kluwer, 2020-09) Maatman, Thomas K.; Jalali, Farid; Feizpour, Cyrus; Douglas, Anthony II; McGuire, Sean P.; Kinnaman, Gabriel; Hartwell, Jennifer L.; Maatman, Benjamin T.; Kreutz, Rolf P.; Kapoor, Rajat; Rahman, Omar; Zyromski, Nicholas J.; Meagher, Ashley D.; Surgery, School of MedicineObjectives: The aim of this study was to determine the frequency of venous thromboembolism in critically ill coronavirus disease 2019 patients and associate a degree of inflammatory marker elevation to venous thromboembolism development. Design: An observational study that identified patients with severe coronavirus disease 2019 between March 12, 2020, and March 31, 2020. Data reported are those available through May 6, 2020. Setting: A multicenter study including three Indianapolis area academic hospitals. Patients: Two-hundred forty consecutive patients with confirmed severe acute respiratory syndrome coronavirus 2 infection were admitted to one of three hospitals. One-hundred nine critically ill coronavirus disease 2019 patients admitted to the ICU were included in the analysis. Interventions: All patients received routine subcutaneous chemical venous thromboembolism prophylaxis. Measurements and main results: The primary outcome of this study was to determine the frequency of venous thromboembolism and the degree of inflammatory and coagulation marker elevation associated with venous thromboembolism development. Descriptive statistics outlined the frequency of venous thromboembolism at any time during severe coronavirus disease 2019. Clinical course and laboratory metrics were compared between patients that developed venous thromboembolism and patients that did not develop venous thromboembolism. Hypercoagulable thromboelastography was defined as two or more hypercoagulable parameters. Main results: One-hundred nine patients developed severe coronavirus disease 2019 requiring ICU care. The mean (± SD) age was 61 ± 16 years and 57% were male. Seventy-five patients (69%) were discharged home, 7 patients (6%) remain in the hospital, and 27 patients (25%) died. Venous thromboembolism was diagnosed in 31 patients (28%) 8 ± 7 days after hospital admission, including two patients diagnosed with venous thromboembolism at presentation to the hospital. Elevated admission D-dimer and peak D-dimer were associated with venous thromboembolism development (p < 0.05). D-dimer greater than 2,600 ng/mL predicted venous thromboembolism with an area under the receiver operating characteristic curve of 0.760 (95% CI, 0.661-0.858; p < 0.0001), sensitivity of 89.7%, and specificity of 59.5%. Twelve patients (11%) had thromboelastography performed and 58% of these patients had a hypercoagulable study. The calculated coagulation index was hypercoagulable in 50% of patients with thromboelastography. Conclusions: These data show that coronavirus disease 2019 results in a hypercoagulable state. Routine chemical venous thromboembolism prophylaxis may be inadequate in preventing venous thromboembolism in severe coronavirus disease 2019.Item Venous thromboembolism and COVID-19: a case report and review of the literature(Springer Nature, 2020-10-15) Bhatt, Harshil U.; Singh, Sandeep; Medicine, School of MedicineBackground: Currently, there is minimal data available highlighting the prevalence of venous thromboembolism in patients infected with coronavirus disease 2019 (COVID-19). This case report with a literature review emphasizes a unique presentation of COVID-19 that is highly important for health care providers to consider when treating their patients. Case report: A 65-year-old Caucasian male patient presented to the emergency department with a 2-day history of dyspnea on exertion after his wife’s recent diagnosis of COVID-19. He additionally had experienced a couple of episodes of self-resolving diarrhea a few days before presentation. Based on the patient’s clinical presentation and the laboratory workup identifying an elevated D-dimer, a computed tomography angiogram of the chest was obtained, which was significant for moderately large, bilateral pulmonary emboli with a saddle embolus, and an associated small, left lower lobe, pulmonary infarct. Ultrasound of the lower extremity showed non-occlusive deep vein thrombosis at the distal left femoral vein to the left popliteal vein. The patient was additionally diagnosed with COVID-19 when the results of the COVID-19 polymerase chain reaction test returned as positive. The patient was admitted to the COVID unit, and he was started on an intravenously administered, unfractionated heparin drip for management of his bilateral pulmonary emboli and deep vein thrombosis. The patient’s clinical condition improved significantly with anticoagulation, and he was observed in the hospital for 3 days, after which he was discharged home on the enoxaparin bridge with warfarin. Post-discharge telephone calls at day 10 and week 4 revealed that the patient was appropriately responding to anticoagulation treatment and had no recurrence of his symptoms related to venous thromboembolism and COVID-19. Conclusion: As COVID-19 continues to lead to significant mortality, more data is emerging that is exposing its perplexing pathogenicity. Meanwhile, the presentation of venous thromboembolism in patients with COVID-19 remains an unusual finding. It is imperative for health care providers to be mindful of this unique association to make necessary diagnostic evaluations and provide appropriate treatment for the patients.Item Venous Thromboembolism and D-dimer In Patients with COVID-19(Indiana Medical Student Program for Research and Scholarship (IMPRS), 2020-12-15) Hoffer, Joshua; Stewart, Lauren; Pettit, Kate; Kline, Jeffrey A.; Department of Emergency Medicine, IU School of MedicineBackground and Hypothesis: The potential association between venous thromboembolism (VTE) and COVID-19 is an area of growing research, and methods of effective prophylaxis, detection, and treatment continue to be sought. D-dimer assays have been previously established as a highly sensitive — albeit nonspecific — test to assess patient risk of VTE, but the full clinical utility of this test in COVID-19 patients is currently not well understood. We hypothesized that, in patients presenting to the emergency department (ED) and determined to be positive for COVID-19, an elevated D-dimer value is associated with an increased 30-day incidence of VTE. Project Methods: Deidentified patient encounter data was collected and analyzed from a multicenter registry of ED patients tested for SARS-CoV-2. We measured the frequency of a positive SARS-CoV-2 test and compared the incidence of VTE between SARS-CoV-2 positive and negative patients. We also compared average D-dimer values in SARS-CoV-2 positive patients with and without VTE. Results: Of 6,445 patient encounters queried, 2,051 tested positive for SARS-CoV-2 (32%). SARS-CoV-2 positive patients had a significantly higher incidence of VTE in the 30-day follow-up period compared to SARS-CoV-2 negative patients (3.2 vs. 1.6%, p= 0.0002). D-dimer values were available for 537 of these SARS-CoV-2 patients, with an average D-dimer of 1813.83 ng/mL. The average D-dimer in SARS-CoV-2 positive patients who did develop VTE tended to be higher than those who did not develop VTE (2969 ng/mL vs. 1822 ng/mL), although this difference was not statistically significant (p=0.34). The fitted areas for binomial receiver operating characteristic curves of D-dimer for detection of VTE in patients with and without SARS-CoV-2 were 0.628 and 0.829, respectively. Conclusion and Potential Impact: We found a positive SARS-CoV-2 test to be associated with a higher incidence of VTE. However, an elevated D-dimer continues to be nonspecific for VTE in SARS-CoV-2 positive patients, and performs more poorly in SARS-CoV-2 positive patients than in negative patients. Additional clinical criteria should be identified to further guide the use of diagnostic imaging modalities and prophylactic anticoagulation in COVID-19 positive patients with suspicion of VTE.