Extremely High Incidence of Lower Extremity Deep Venous Thrombosis in 48 Patients With Severe COVID-19 in Wuhan
Authors: Bin Ren, Feifei Yan, Zhouming Deng, Sheng Zhang, Lingfei Xiao, Meng Wu, Lin Cai
Journal: Circulation (2020)

COVID-19 ◼ venous thrombosisT he coronavirus disease 2019 (COVID-19) pandemic has caused >4 million infections and 280 000 deaths worldwide (as of May 13, 2020).The case fatality ratio in China (as of February 11, 2020) was 2.3%, but that number among hospitalized critical patients was 49.0%. 1 The reason for the high case fatality ratio in critical patients with COVID-19 is not completely clear.During the 2002 severe acute respiratory syndrome pandemic, the incidences of deep vein thrombosis (DVT) and pulmonary embolism were 20.5% and 11.4% in autopsy cases. 2 Whether thrombosis contributes to the high mortality of COVID-19 remains unclear.As the global fight against COVID-19 continues, our study examined how prevalent thrombosis formation is for patients with COVID-19.A cross-sectional study was carried out in 2 hospitals in Wuhan, China, from February 29, 2020 to March 2, 2020.Patients were enrolled from the intensive care unit of Zhongnan Hospital of Wuhan University and Leishenshan Hospital, a newly constructed hospital designated for COVID-19 in Wuhan.Patients with confirmed COVID-19 in intensive care unit treatment (excluding patients with prior DVT or recent surgery) received compression ultrasound examinations in the lower extremities.The examinations were performed at least twice by the experienced sonographer team blinded to patient clinical history.Deep veins from the inguinal ligament to the ankle, including the femoral vein, popliteal vein, posterior tibial vein, peroneal vein, and intermuscular vein in the calf, were examined.Laboratory findings were gathered at the first assessment after patients were admitted to the intensive care unit.The study was approved by the Medical Ethical Committee of Zhongnan Hospital of Wuhan University (approval 2020031).Oral consent was obtained from patients or direct relatives.For the enrolled 48 critically ill patients with COVID-19, the median age was 70 years (interquartile range, 62-80 years; Table ).All but 1 patient (with coagulation contradiction) received 30 to 40 mg low-molecular-weight heparin (subcutaneous injection once daily) as anticoagulation.Lower extremity DVTs were detected in 41 patients (85.4%), with 36 (75%) isolated distal DVTs and 5 (10.4%) proximal DVT.The APACHE II (Acute Physiology and Chronic Health Evaluation II) score was 16 (9-24).In terms of comorbidities, the numbers of patients with hypertension, diabetes mellitus, previous cardiovascular disease, and previous cerebrovascular disease were 19 (39.6%), 13 (27.1%),11 (22.9%), and 7 (14.6%),respectively.All patients exhibited abnormal levels of inflammatory indicators, including an elevation of neutrophil count and a reduction of lymphocyte count.Of the 29 patients who received mechanical ventilation, 18 had endotracheal intubation.The median levels of D-dimer in patients with no DVT, isolated distal DVT, and proximal DVT were 0.90 mg/L (0.51-3.10 mg/L), 5.31 mg/L (1.12-9.78mg/L), and 3.53 mg/L (1.87-11.64mg/L), respectively (P=0.09), which were above the superior limit.In terms of patient deaths, as of April 16, 2020, 2 patients (28.