• Carles García-Cervera, Vicente Giner-Galvañ, Philip Wikman-Jorgensen, Jaime Laureiro, Manuel Rubio-Rivas, Anthony Gurjian Arena, Francisco Arnalich-Fernandez, José Luis Beato Pérez, Juan Antonio Vargas Núñez, Jesús Javier González Igual, Jesús Díez-Manglano, Manuel Méndez Bailón, María José García Blanco, Santiago J Freire Castro, Judit Aranda Lobo, Luis Manzano, Jeffrey Oskar Magallanes Gamboa, Luis Arribas Pérez, Julio González Moraleja, Ruth Calderón Hernaiz, Javier García Alegría, Amara González Noya, Ricardo Gómez Huelgas, Carlos Lumbreras Bermejo, Juan Miguel Antón Santos, and SEMI-COVID-19 Network.
• General Internal Medicine Department, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain.
• J Gen Intern Med. 2021 Nov 1; 36 (11): 3478-3486.

BackgroundVenous thrombotic events (VTE) are frequent in COVID-19, and elevated plasma D-dimer (pDd) and dyspnea are common in both entities.ObjectiveTo determine the admission pDd cut-off value associated with in-hospital VTE in patients with COVID-19.MethodsMulticenter, retrospective study analyzing the at-admission pDd cut-off value to predict VTE and anticoagulation intensity along hospitalization due to COVID-19.ResultsAmong 9386 patients, 2.2% had VTE: 1.6% pulmonary embolism (PE), 0.4% deep vein thrombosis (DVT), and 0.2% both. Those with VTE had a higher prevalence of tachypnea (42.9% vs. 31.1%; p = 0.0005), basal O2 saturation <93% (45.4% vs. 33.1%; p = 0.0003), higher at admission pDd (median [IQR]: 1.4 [0.6-5.5] vs. 0.6 [0.4-1.2] μg/ml; p < 0.0001) and platelet count (median [IQR]: 208 [158-289] vs. 189 [148-245] platelets × 109/L; p = 0.0013). A pDd cut-off of 1.1 μg/ml showed specificity 72%, sensitivity 49%, positive predictive value (PPV) 4%, and negative predictive value (NPV) 99% for in-hospital VTE. A cut-off value of 4.7 μg/ml showed specificity of 95%, sensitivity of 27%, PPV of 9%, and NPV of 98%. Overall mortality was proportional to pDd value, with the lowest incidence for each pDd category depending on anticoagulation intensity: 26.3% for those with pDd >1.0 μg/ml treated with prophylactic dose (p < 0.0001), 28.8% for pDd for patients with pDd >2.0 μg/ml treated with intermediate dose (p = 0.0001), and 31.3% for those with pDd >3.0 μg/ml and full anticoagulation (p = 0.0183).ConclusionsIn hospitalized patients with COVID-19, a pDd value greater than 3.0 μg/ml can be considered to screen VTE and to consider full-dose anticoagulation.© 2021. Society of General Internal Medicine.

18 keywords...

hide…