Sebuhyan M, Mirailles R, Crichi B, Frere C, Bonnin P, Bergeron-Lafaurie A, Denis B, Liegeon G, Peyrony O, Farge D
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-Vellefaux, 75010 Paris, France.
J Med Vasc. 2020 Dec;45(6):334-343. doi: 10.1016/j.jdmv.2020.08.002. Epub 2020 Sep 4.
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).
Non-systematic review of the literature.
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.
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.
世界卫生组织已宣布2019冠状病毒病疫情（COVID-19）为大流行。研究报告称，重症COVID-19病例存在严重炎症综合征和促凝状态，静脉血栓栓塞症增加，包括肺栓塞（PE）和深静脉血栓形成（DVT）。在此背景下，我们讨论在非重症监护病房（ICU）的门诊和住院COVID-19患者或疑似患者中，使用多普勒超声检查（DUS）筛查和诊断DVT的情况。
对文献进行非系统性综述。
对于因COVID-19感染住院或疑似感染的患者，若存在以下情况之一：（a）DVT临床症状；（b）DVT临床高度可能性（Wells评分>2）；或（c）D-二聚体水平升高但无DVT临床症状且肺部CT血管造影未发现PE，则应用DUS对DVT进行检查。在临床和/或影像学诊断为PE的情况下，不建议在COVID-19大流行期间使用DUS进行额外的系统性DVT筛查。在这种情况下，使用四点压迫DUS进行DVT筛查和诊断是最合适的方法。
不建议对无症状COVID患者进行系统性DUS筛查DVT，除非患者在ICU。在此期间，这会增加医护人员不必要接触严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的风险，并占用有限资源。
