Johnson Steven E, Pai Eric, Voroba Ashley, Chen Nai-Wei, Bahl Amit
Emergency Medicine, Beaumont Health, Royal Oak, USA.
Emergency Medicine, Northwell Health, Manhasset, USA.
Cureus. 2022 Jul 15;14(7):e26883. doi: 10.7759/cureus.26883. eCollection 2022 Jul.
Objective Thrombosis is thought to occur frequently in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to elucidate the relationship between macro/microvascular thrombosis, D-dimer levels, and empiric anticoagulation in coronavirus disease 2019 (COVID-19). Methods This was an exploratory prospective, single-site, observational study. Adult emergency department patients with COVID-19 requiring hospitalization received a point-of-care lower extremity venous duplex ultrasound. The primary endpoint was thromboembolism and associated D-dimer level. Secondary endpoints included rates of micro and macro thrombotic complications as well as empiric anticoagulant use. Results Between January 13 and April 12 2021, 52 patients were enrolled. Median D-dimer at presentation was 650 ng/mL (range 250-10,000 ng/mL) among patients with negative duplex studies. During hospitalization, 18 patients underwent 20 additional studies assessing for venous thromboembolism (VTE). These studies yielded one deep vein thrombosis (DVT) diagnosis. Among patients with negative studies median D-dimer was 1,246 ng/mL (range 329-10,000 ng/mL). Two patients experienced microvascular complications. Seven patients were started on empiric full dose anticoagulation. Conclusion While VTE remains a major concern amongst patients with COVID-19, the normal D-dimer cut off of >500 ng/mL likely should not be used to initiate further VTE workup. Additionally, moderately elevated D-dimer did not correlate strongly with microvascular complications and may not be relevant in the decision to initiate empiric anticoagulation.
目的 血栓形成被认为在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的情况下经常发生。我们旨在阐明2019冠状病毒病（COVID-19）中宏观/微血管血栓形成、D-二聚体水平与经验性抗凝之间的关系。方法 这是一项探索性前瞻性单中心观察性研究。因COVID-19需要住院治疗的成年急诊科患者接受了即时床旁下肢静脉双功超声检查。主要终点是血栓栓塞及相关的D-二聚体水平。次要终点包括微血管和大血管血栓形成并发症的发生率以及经验性抗凝药物的使用情况。结果 在2021年1月13日至4月12日期间，共纳入52例患者。双功超声检查阴性的患者就诊时D-二聚体中位数为650 ng/mL（范围250 - 10,000 ng/mL）。住院期间，18例患者接受了另外20次评估静脉血栓栓塞（VTE）的检查。这些检查确诊了1例深静脉血栓形成（DVT）。检查结果阴性的患者中，D-二聚体中位数为1,246 ng/mL（范围329 - 10,000 ng/mL）。2例患者出现微血管并发症。7例患者开始接受经验性全剂量抗凝治疗。结论 虽然VTE仍然是COVID-19患者的主要关注点，但正常的D-二聚体临界值>500 ng/mL可能不应被用于启动进一步的VTE检查。此外，D-二聚体中度升高与微血管并发症的相关性不强，可能与启动经验性抗凝治疗的决策无关。
