Dasari Naresh, Banga Akshat, Pallipamu Namratha, Pandit Trupti, Pandit Ramesh, Adhikari Ramesh
Internal Medicine, Roger Williams Medical Center, Providence, USA.
Internal Medicine, Sawai Man Singh Medical College, Jaipur, IND.
Cureus. 2022 Oct 3;14(10):e29859. doi: 10.7759/cureus.29859. eCollection 2022 Oct.
The coronavirus disease 2019 (COVID-19) continues to be a devastating disease for the elderly population, especially in long-term care facilities, and it presents with varying clinical presentations. We have ample evidence that COVID-19 can predispose to deep vein thrombosis (DVT) and pulmonary embolism (PE) during an active infection. Still, very few cases of DVT have been reported after recovery from COVID-19. The imbalance of the coagulation cascade and the increased release of certain coagulation factors play an essential role in promoting hypercoagulability and vascular endothelial dysfunction. It leads to a rise in the level of fibrin degradation products, D-dimers, which can remain elevated for up to several weeks, even after recovery. It has been suggested that the risk of DVT occurring after recovering from COVID-19 remains high for up to three months. We report a case of a 77-year-old long-term care female resident at a nursing facility, ambulatory at baseline, who was noted to be COVID-19 positive upon routine facility-wide testing per department of health guidelines. She was asymptomatic during her 10-day quarantine period. D-dimer levels during routine labs were high (initial D-dimer level of 1.87 mg/L FEU {normal value: 0.19-0.52 mg/L FEU}), but the patient had no clinical signs and symptoms of DVT. Ultrasound of the bilateral legs was not performed due to low clinical suspicion. The patient received an enoxaparin DVT prophylaxis dose during the quarantine period. Follow-up D-dimer levels were done at frequent intervals after recovery, but D-dimer levels continued to remain elevated up till six weeks after her 10-day quarantine period ended. Based on previous experience with other long-term care residents who suffered from COVID-19, bilateral lower extremity ultrasound was performed, which showed bilateral DVT. Elevated D-dimer levels are a predictor of hypercoagulation complications in COVID-19. Patients with persistently elevated D-dimer levels after recovery from COVID-19 should be screened for thromboembolic complications, even if they are asymptomatic. DVT can occur up to three months post-recovery from COVID-19 infection.
2019冠状病毒病（COVID-19）对老年人群来说仍然是一种具有毁灭性的疾病，尤其是在长期护理机构中，并且它具有多种临床表现。我们有充分的证据表明，COVID-19在活跃感染期间易引发深静脉血栓形成（DVT）和肺栓塞（PE）。然而，从COVID-19康复后报告的DVT病例仍然非常少。凝血级联反应的失衡以及某些凝血因子释放的增加在促进高凝状态和血管内皮功能障碍方面起着至关重要的作用。这导致纤维蛋白降解产物D-二聚体水平升高，即使在康复后，该水平也可能持续升高长达数周。有人提出，从COVID-19康复后发生DVT的风险在长达三个月的时间内仍然很高。我们报告了一例77岁的女性长期护理机构居民，基线时可走动，根据卫生部门指南在机构进行全范围常规检测时被发现COVID-19呈阳性。在为期10天的隔离期内她没有症状。常规实验室检查时D-二聚体水平很高（初始D-二聚体水平为1.87 mg/L FEU{正常值：0.19 - 0.52 mg/L FEU}），但患者没有DVT的临床体征和症状。由于临床怀疑度低，未对双侧腿部进行超声检查。在隔离期间患者接受了依诺肝素预防DVT的剂量。康复后定期进行D-二聚体水平随访，但直到她10天隔离期结束后的六周，D-二聚体水平仍持续升高。根据之前对其他感染COVID-19的长期护理机构居民的经验，进行了双侧下肢超声检查，结果显示双侧DVT。D-二聚体水平升高是COVID-19高凝并发症的一个预测指标。从COVID-19康复后D-二聚体水平持续升高的患者，即使无症状，也应筛查血栓栓塞并发症。COVID-19感染康复后长达三个月都可能发生DVT。
