High prevalence of occult thrombosis in mild/moderate COVID-19

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Highlights

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The incidence of venous thromboembolism is high among mild/moderate COVID-19 cases.
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Despite of thrombosis, tests for inflammatory, coagulation and biochemistry parameters were all in normal scope.
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The conventional method by Doppler ultrasound tend to underestimate the rate of thrombosis in comparisons to CTPA + CTV method.

Abstract

Background and purpose

More and more reports had observed the thrombosis in severe COVID-19 cases. The aim of this study was to evaluate the incidence of thromboembolism in mild/ moderate COVID-19. All of the patients had normal coagulation tests and had no overt thrombotic complications. It is important to screen the thrombotic status in mild/moderate COVID-19.

Methods

From June 11 to July 8, 2020, 23 patients with mild/ moderate COVID-19 pneumonia consented to having a CTPA (CT pulmonary angiography) + CTV (CT venography) scans for the lung and extremity veins. Doppler ultrasound (DUS) was performed in all patients for screening. The incidence, clinical manifestations, laboratory examinations, imaging features and prognosis of patients with venous thromboembolism (VTE) were analyzed and compared with those COVID-19 pneumonia patients without VTE.

Results

19 patients (82.6%) had VTE, mainly distal limb thrombosis. Only one of the VTE were screened by DUS, the other VTE were negative by DUS. All of the mild / moderate patients with VTE were screened by CTPA + CTV. The blood tests for inflammatory, coagulation and biochemistry parameters were all in normal scope except for the WBC and LDH.

Conclusions

With CTV screening for DVT, we found the incidence of thrombosis in mild to moderate COVID-19 patients was soared to 82.6% (19/23). Screening for thrombosis is important in COVID-19. CTV is more sensitive than the DUS in detecting thrombosis. More research is needed to evaluate the significance of thrombosis in COVID-19 pneumonia.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Infect Dis

Journal ID (iso-abbrev): Int J Infect Dis

Title: International Journal of Infectious Diseases

Publisher: The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

ISSN (Print): 1201-9712

ISSN (Electronic): 1878-3511

Publication date PMC-release: 19 December 2020

Publication date (Electronic): 19 December 2020

Affiliations

[a ]The radiology department, Beijing Ditan Hospital, Capital Medical University, Beijing, China

[b ]Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

[c ]The infectious disease diagnostic, therapeutic and research centers, Beijing Ditan Hospital, Capital Medical University, Beijing, China

[d ]Department of Otolaryngology Head and Neck Surgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China

[e ]Center of liver disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China

[f ]Infectious Diseases, Nuffield Department of Medicine, University of Oxford, Oxford, UK

Author notes

[* ]Corresponding authors at: Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun Dongjie, Chaoyang District, Beijing 100015, China.

[1]

These authors contributed equally to this work.

Article

Publisher Item ID: S1201-9712(20)32566-2

DOI: 10.1016/j.ijid.2020.12.042

PMC ID: 7749732

PubMed ID: 33352324

SO-VID: 2b15574e-1fe0-4f3f-a53c-71a65f7a45c0

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

History

Date received : 6 October 2020

Date revision received : 14 December 2020

Date accepted : 15 December 2020

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