Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
Intensive Care Unit, Royal Brompton Hospital, London, UK.
J Thromb Thrombolysis. 2021 Nov;52(4):985-991. doi: 10.1007/s11239-021-02474-8. Epub 2021 May 21.
Pulmonary thromboembolism and deep venous thrombosis occur frequently in hospitalised patients with COVID-19, the prevalence increases on the intensive care unit (ICU) and is very high in patients on extracorporeal membrane oxygenation (ECMO). We undertook a literature review to assess the usefulness of screening for peripheral venous thrombosis or pulmonary thrombosis in patients admitted with COVID-19. Outside of the ICU setting, D-dimer elevation on presentation or marked increase from baseline should alert the need for doppler ultrasound scan of the lower limbs. In the ICU setting, consideration should be given to routine screening with doppler ultrasound, given the high prevalence of thrombosis in this cohort despite standard anticoagulant thromboprophylaxis. However, absence of lower limb thrombosis on ultrasound does not exclude pulmonary venous thrombosis. Screening with CT pulmonary angiography (CTPA) is not justified in patients on the general wards, unless there are clinical features and/or marked elevations in markers of COVID-19-associated coagulopathy. However, the risk of pulmonary embolism or pulmonary thrombosis in ICU patients is very high, especially in patients on ECMO, where studies that employed routine screening for thrombosis with CT scanning have uncovered up to 100% incidence of pulmonary thrombosis despite standard anticoagulant thromboprophylaxis. Therefore, in patients at low bleeding risk and high clinical suspicion of venous thromboembolism, therapeutic anticoagulation should be considered even before screening, Our review highlights the need for increased vigilance for VTE, with a low threshold for doppler ultrasound and CTPA in high risk in-patient cohorts, where clinical features and D-dimer levels may not accurately reflect the occurrence of pulmonary thromboembolism.
COVID-19 住院患者常并发肺血栓栓塞症和深静脉血栓形成，重症监护病房（ICU）患者的发病率增加，体外膜肺氧合（ECMO）患者的发病率极高。我们进行了文献回顾，以评估在 COVID-19 住院患者中筛查外周静脉血栓形成或肺血栓形成的有用性。在非 ICU 环境中，就诊时 D-二聚体升高或与基线相比明显升高应提示需要进行下肢多普勒超声检查。在 ICU 环境中，尽管对该队列进行了标准抗凝血栓预防，但鉴于血栓形成的高发生率，应考虑常规进行多普勒超声筛查。然而，下肢血栓形成的超声检查结果并不能排除肺静脉血栓形成。除非存在 COVID-19 相关凝血功能障碍的临床特征和/或标志物明显升高，否则在普通病房患者中，不应对 CT 肺动脉造影（CTPA）进行筛查。然而，ICU 患者的肺栓塞或肺血栓形成风险非常高，尤其是在 ECMO 患者中，尽管进行了常规 CT 扫描筛查血栓形成，但研究发现，在标准抗凝血栓预防的情况下，肺血栓形成的发生率高达 100%。因此，在低出血风险和高临床怀疑静脉血栓栓塞的患者中，即使在筛查之前，也应考虑进行抗凝治疗。我们的综述强调了需要提高对 VTE 的警惕性，对于高风险住院患者，应降低多普勒超声和 CTPA 的阈值，因为临床特征和 D-二聚体水平可能无法准确反映肺血栓栓塞的发生。
