• Anabel Franco-Moreno, Maria Herrera-Morueco, Beatriz Mestre-Gómez, Nuria Muñoz-Rivas, Ane Abad-Motos, Danilo Salazar-Chiriboga, Mercedes Duffort-Falcó, Pilar Medrano-Izquierdo, Ana Bustamante-Fermosel, Virginia Pardo-Guimera, Mariano Ulla-Anés, Juan Torres-Macho, and Infanta Leonor Thrombosis Research Group.
• Department of Internal Medicine, Infanta Leonor University Hospital, Madrid, Spain.
• J Ultrasound Med. 2020 Oct 5.

ObjectivesSeveral reports had observed a high risk of pulmonary embolism (PE) in patients with coronavirus disease 2019 (COVID-19), most of them in the intensive care unit. Reported findings indicate that a direct viral-mediated hyperinflammatory response leads to local thromboinflammation. According to those findings, the incidence of deep venous thrombosis (DVT) in patients with COVID-19 and PE should be low. The objective of this study was to evaluate the incidence of DVT in patients with COVID-19 who developed PE.MethodsIn this prospective observational study, consecutive patients hospitalized in the internal medicine ward with a diagnosis of COVID-19 who developed PE were screened for DVT in the lower extremities with complete compression ultrasound.ResultsThe study comprised 26 patients. Fifteen patients (57.7%) were male. The median age was 60 years (interquartile range, 54-73 years). Compression ultrasound findings were positive for DVT in 2 patients (7.7%; 95% confidence interval, 3.6%-11.7%). Patients with DVT had central and bilateral PE. In both, venous thromboembolism was diagnosed in the emergency department, so they did not receive previous prophylactic therapy with low-molecular-weight heparin. Patients without DVT had higher median d-dimer levels: 25,688 μg/dL (interquartile range, 80,000-1210 μg/dL) versus 5310 μg/dL (P < .05).ConclusionsOur study showed a low incidence of DVT in a cohort of patients with COVID-19 and PE. This observation suggests that PE in these patients could be produced mainly by a local thromboinflammatory syndrome induced by severe acute respiratory syndrome coronavirus 2 infection and not by a thromboembolic event.© 2020 American Institute of Ultrasound in Medicine.

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