Prevalence of asymptomatic deep vein thrombosis in patients hospitalized with SARS-CoV-2 pneumonia: a cross-sectional st
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Prevalence of asymptomatic deep vein thrombosis in patients hospitalized with SARS‑CoV‑2 pneumonia: a cross‑sectional study Matteo Giorgi‑Pierfranceschi1 · Oriana Paoletti2 · Angelo Pan3 · Fabio De Gennaro1 · Anna Laura Nardecchia1 · Rossella Morandini2 · Claudia Dellanoce2 · Samuele Lombi1 · Maurizio Tala2 · Vanessa Cancelli2 · Silvia Zambelli2 · Giancarlo Bosio4 · Laura Romanini5 · Sophie Testa2 Received: 16 May 2020 / Accepted: 5 August 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract The association between coronavirus disease 2019 (COVID-19) pneumonia and venous thrombotic disorders is still unclear. We assessed the association between COVID-19 infection-related pneumonia and proximal deep-vein thrombosis (DVT) in a cohort of patients admitted to our hospital during the European outbreak in the front line of Cremona, Lombardy. In a single-center cross-sectional study, all patients hospitalized for more than 5 days in Internal Medicine Department with confirmed COVID-19 pneumonia received 2-point compressive ultrasound assessment (CUS) of the leg vein system during a single day. Ninety-four percent of patients received enoxaparin as standard pharmacological prophylaxis for venous thromboembolism. The presence of DVT was defined as incompressibility of popliteal or common femoral vein. Out of 121 patients with COVID-19 pneumonia (mean age 71.8, 66.3% males) hospitalized on March 31st, 70 stayed in hospital for over 5 days and 66 of them underwent CUS of deep venous system of the legs. The presence of asymptomatic DVT was found in 9 patients (13.6%). No symptomatic DVT was found. Patients with DVT showed mean age = 75.7 years, mean D-dimer levels = 4.02 ng/ml and all of them received enoxaparin for thromboprophylaxis, except one. Computed tomography pulmonary angiogram confirmed pulmonary embolism in five patients. One every seven patients with COVID-19-related pneumonia, hospitalized for more than 5 days, had asymptomatic proximal DVT and half of them had confirmed PE despite standard pharmacological thromboprophylaxis. This observational study suggests the need of an active surveillance through CUS in patients hospitalized with acute SARS-COV-2 and underline the need of a more intense thromboprophylaxis. Keywords Prevalence · Asymptomatic deep veins thrombosis · Covid-19 pneumonia · Point of care ultrasonography
Introduction
* Matteo Giorgi‑Pierfranceschi [email protected] 1
Department of Internal Medicine, Hospital of Cremona, Viale Concordia 1, 26100 Cremona, Italy
2
Haemostasis and Thrombosis Center, Hospital of Cremona, Cremona, Italy
3
Department of Infectious Disease, Hospital of Cremona, Cremona, Italy
4
Department of Pneumology, Hospital of Cremona, Cremona, Italy
5
Department of Radiology, Hospital of Cremona, Cremona, Italy
The World Health Organization on March 11th 2020 declared the novel coronavirus infection COVID-19 a global pandemic [1, 2]. Italy, particularly the area of Cremona located in the northern region, was notified as the first E
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