Incidence of Deep Venous Thrombosis in Recently Diagnosed Mild and Moderate Cases Of COVID-19 Patients

Abstract

Background: Coronavirus disease 2019 (COVID-19) is an infectious viral respiratory disease that is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and may lead to venous thromboembolism (VTE) due to vascular endothelium dysfunction, hyper-inflammatory immune response and hypercoagulability.

Objectives: The aim of our study is to detect the incidence of lower limbs DVT on early presentation of mild and moderate COVID-19 cases and the practicability of Duplex ultrasound screening for DVT in these cases.

Methods: We performed a prospective cohort study that included one-hundred-eighty mild and moderate COVID-19 patients by non- random sampling of patients who have been presented at our authorized hospitals. Study cases underwent clinical assessment for signs of DVT including calculation of the two level DVT Wells score. Regardless the symptoms and Wells score; all included patients were subjected to bilateral lower limb venous duplex examination from external iliac to tibial veins. D-dimer levels have been recorded. Another confirmatory Duplex study was performed within one week from the first duplex to safely exclude DVT in the patients who had first normal venous duplex.

Results: Our study included 121 male patients and 59 female patients. The mean age of the study population was 25.475±6.030. The diagnosis of DVT depending on bilateral lower limbs venous duplex study in our study was confirmed in seventeen patients denoting an incidence of 9.4%; nine patients were diagnosed as distal DVT representing 52.94% of the DVT cases while proximal DVT was present in eight patients. The DVT was unilateral in all of the seventeen cases. The level of D-dimer in our study population (measured in ng/ml) ranged from 185 – 1347 with a mean of 497.85 ± 209.82. In the DVT cases group The D-dimer levels ranged from 788-1347 ng/ml with a mean of 1027.24 ± 136.71 (P-value < 0.001).

Conclusion: The incidence of lower limb DVT in mild and moderate COVID-19 patients included in our study was 9.4% concluding that COVID-19 can be considered as a risk factor for DVT even in non-critically ill COVID-19 patients. Lower limb venous duplex study might be considered in COVID-19 patients depending on Wells score and D-dimer level as a predictive model for DVT in those patients. Confirmed COVID-19 diagnosis could be included in VTE prediction score risk assessment systems.