How to screen and diagnose deep venous thrombosis (DVT) in patients hospitalized for or suspected of COVID-19 infection, outside the intensive care units - 26/11/20

Doi : 10.1016/j.jdmv.2020.08.002

M. Sebuhyan ^a,^⁎ , R. Mirailles ^a, B. Crichi ^a, C. Frere ^b, P. Bonnin ^c, A. Bergeron-Lafaurie ^d, B. Denis ^e, G. Liegeon ^e, O. Peyrony ^f, D. Farge ^a,^g,^h,^⁎
for the
Saint-Louis CORE (COVID-19 RESEARCH) group
^a Unité de médecine interne : maladies auto-immunes et pathologie vasculaire (UF04), hôpital Saint-Louis, Assistance publique–Hôpitaux de Paris (AP–HP), 1, avenue Claude-Vellefaux, 75010 Paris, France
^b Inserm UMRS_1166, service d’hématologie biologique, Sorbonne université, hôpital Pitié-Salpêtrière, Assistance publique–Hôpitaux de Paris (AP–HP), 47–83, boulevard de l’Hôpital, 75013 Paris, France
^c Service de physiologie clinique et explorations fonctionnelles, hôpital Lariboisière, Assistance publique–Hôpitaux de Paris (AP–HP), Paris, France
^d Service de pneumologie, hôpital Saint-Louis, Assistance publique–hôpitaux de Paris (AP–HP), 1, avenue Claude-Vellefaux, 75010 Paris, France
^e Service de maladie infectieuse, hôpital Saint-Louis, Assistance publique–Hôpitaux de Paris (AP–HP), 1, avenue Claude-Vellefaux, 75010 Paris, France
^f Service des urgences, hôpital Saint-Louis, Assistance publique–Hôpitaux de Paris (AP–HP), 1, avenue Claude-Vellefaux, 75010 Paris, France
^g IRSL, EA-3518, recherche clinique appliquée à l’hématologie, université de Paris, 75010 Paris, France
^h Department of medicine, McGill university, Montreal, QC, Canada

^⁎Corresponding authors at: Unité de médecine interne : maladies auto-immunes et pathologie vasculaire (UF04), hôpital Saint-Louis, Assistance publique–Hôpitaux de Paris (AP–HP), 1, avenue Claude-Vellefaux, 75010 Paris, France.Unité de médecine interne : maladies auto-immunes et pathologie vasculaire (UF04), hôpital Saint-Louis, Assistance publique–Hôpitaux de Paris (AP–HP)1, avenue Claude-VellefauxParis75010France

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Summary

Introduction

The Coronavirus disease-2019 outbreak (COVID-19) has been declared a pandemic by the World Health Organization. Studies report both a severe inflammatory syndrome and a procoagulant state in severe COVID-19 cases, with an increase of venous thromboembolism, including pulmonary embolism (PE) and deep vein thrombosis (DVT). In this context, we discuss the use of doppler ultrasonography (DUS) in the screening and diagnosis of DVT in ambulatory and hospitalized patients with, or suspected of having, COVID-19, outside the intensive care unit (ICU).

Material and methods

Non-systematic review of the literature.

Results

In patients hospitalized for or suspected of COVID-19 infection with the presence of either (a) DVT clinical symptoms, (b) a strong DVT clinical probability (Wells score>2) or (c) elevated D-dimer levels without DVT clinical symptoms and without PE on lung CT angio-scan, DVT should be investigated with DUS. In the presence of PE diagnosed clinically and/or radiologically, additional systematic DVT screening using DUS is not recommended during the COVID-19 pandemic. The use of 4-points compression DUS for DVT screen and diagnosis is the most appropriate method in this context.

Discussion

Systematic DUS for DVT screening in asymptomatic COVID patients is not recommended unless the patient is in the ICU. This would increase the risk of unnecessarily exposing medical staff to SARS-CoV-2 and monopolizing limited resources during this period.

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Keywords : Venous thromboembolism, Pulmonary embolism, COVID-19 associated coagulopathy, COVID-19 pandemic, Four-points compression ultrasound, Doppler ultrasound, Wells score

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Introduction

Increased incidence of VTE

COVID-19-associated coagulopathy (CAC)

Should we screen for DVT?

In the presence of clinical signs of DVT?

In the presence of a PE diagnosed clinically and/or radiologically?

In the presence of elevated D-dimer in a patient without clinical symptoms of DVT or PE?

4-point compression ultrasound: method of choice during the COVID-19 period

Impact of COVID-19 on the safety of health care personnel

Conclusion

Disclosure of interest

Esportazione

Vol 45 - N° 6

P. 334-343 - Dicembre 2020 Ritorno al numero

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How to screen and diagnose deep venous thrombosis (DVT) in patients hospitalized for or suspected of COVID-19 infection, outside the intensive care units - 26/11/20

Summary

Introduction

Material and methods

Results

Discussion

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