Department of Internal Medicine, Section Acute Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 970 RD, Groningen, The Netherlands.
General and Acute Internal Medicine Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands.
J Ultrasound. 2023 Mar;26(1):163-168. doi: 10.1007/s40477-022-00689-w. Epub 2022 May 14.
Patients with COVID-19 have an increased risk for venous thrombo-embolism (VTE), especially pulmonary embolism. The exact prevalence of asymptomatic DVT is not known, as is the usefulness of screening for DVT in patients admitted to ward with COVID-19. We have studied the prevalence of asymptomatic DVT.
We performed a cross-sectional observational multi-center study at four university medical centers in The Netherlands. All adult patients admitted with COVID-19 to a medical ward were eligible for inclusion, including patients who were transferred back from the ICU to the ward. The study protocol consisted of weekly cross-sectional rounds of compression ultrasound.
In total, 125 patients were included in the study. A significant proportion of patients (N = 34 (27%)) had developed a VTE during their admission for COVID-19 before the study ultrasound was performed. In most VTE cases (N = 27 (79%)) this concerned pulmonary embolism. A new asymptomatic DVT was found in 5 of 125 patients (4.0%; 95% CI 1.3-9.1%) (Table 2). Nine patients (7.2%; 95% CI 3.3-13.2%) developed a VTE (all PE) diagnosed within 28 days after the screening US was performed.
We have shown a low prevalence (4%) of newly discovered asymptomatic DVT outside the ICU-setting in COVID-19 patients. Despite this low prevalence, nine patients developed PE (7%) within 28 days after ultrasound. This favors the hypothesis of local thrombus formation in the lungs. Based on our findings and literature, we do not recommend US-screening of asymptomatic patients with COVID-19 admitted to the ward.
COVID-19 患者发生静脉血栓栓塞症（VTE），尤其是肺栓塞的风险增加。无症状性 DVT 的确切发生率尚不清楚，对因 COVID-19 而收入病房的患者进行 DVT 筛查的作用也不清楚。我们研究了无症状性 DVT 的发生率。
我们在荷兰的 4 所大学医学中心进行了一项横断面观察性多中心研究。所有因 COVID-19 而收入内科病房的成年患者均符合纳入标准，包括从 ICU 转回病房的患者。研究方案包括每周进行一次横断面的压缩超声检查。
共纳入 125 例患者。在进行研究性超声检查之前，有相当一部分患者（N=34（27%））在因 COVID-19 住院期间已发生 VTE。在大多数 VTE 病例（N=27（79%））中，涉及肺栓塞。在 125 例患者中，有 5 例（4.0%；95%CI 1.3-9.1%）发现了新的无症状性 DVT（表 2）。在进行筛查性 US 后 28 天内，有 9 例（7.2%；95%CI 3.3-13.2%）患者诊断出 VTE（均为 PE）。
我们发现，COVID-19 患者在非 ICU 环境中无症状性 DVT 的新发病率较低（4%）。尽管这一发病率较低，但仍有 9 例患者在超声检查后 28 天内发生了 PE（7%）。这支持了肺部局部血栓形成的假说。根据我们的研究结果和文献，我们不建议对收入病房的无症状 COVID-19 患者进行 US 筛查。
