Harry Spoelstra: Why Prophylactic Anticoagulation Matters in COVID-19-Related Thrombosis
Harry Spoelstra, CardioVascular Surgeon, shared a post on X:
“Incidence of Deep Vein Thrombosis in Patients With COVID-19: A Systematic Review.
A potential devastating C19 complication that has had far too little attention!
Nice review article, highlighting the potential significant mortality risk of DVT/PE( Pulmonary embolism). We would like to add that even older, sometimes even “silent”, or limited DVTs increase recurrence risk, particularly during infectious periods, with COVID-19 recently taking the lead.
“There is a clear pathophysiological connection between COVID-19 and deep vein thrombosis (DVT).”
“Virchow’s Triad describes the components involved in the pathophysiology of DVT:
- hypercoagulability,
- venous stasis(immobility), and
- endothelial dysfunction.
COVID-19 poses a risk for DVT because it generates all of these conditions”, but
- Inflammation
- Comorbidities, and
- Hypoxia
All these factors, often combined, create a prothrombotic state, significantly elevating DVT risk in COVID-19 patients.
“DVT has been shown to have an incidence from 3% to 4.8% (as the lowest documented) and up to 47.5% (as the highest percentage seen in the studies) in patients with COVID-19.”
“Most of the 15 studies reviewed in this systematic review suggested that there is a strong association between COVID-19 and DVT.”
“Patients with elevated D-dimer were the highest predictor correlated to DVT in the context of COVID-19 due to the hypercoagulability and inflammatory state that this represents.”
“The mortality surrounding DVT in COVID-19 patients is the main reason why studies should raise awareness on the importance of thromboprophylaxis and in determining the further relationship between DVT and COVID-19.”
So, COVID-19 increases DVT/PE risk due to inflammation/ endothelial dysfunction with immobility adding to the risk, especially in hospitalized patients. Prior DVT also raises recurrence risk, even in asymptomatic/mild cases. Prophylactic anticoagulation needs your attention/consideration. A post-phlebothrombosis leg for instance carries a high future quality of life loss, but more importantly, a DVT can cause a sudden PE/Death! Therefore, IMHO that all C19 cases need D-dimer screening and subsequent thrombosis prophylaxis(= my policy!)”
Title: Incidence of Deep Vein Thrombosis in Patients With COVID-19: A Systematic Review
Authors: Secades Daniela; Dufner Krieger Sebastián; Hidalgo Ramos Roberto A; Hong, Isaac; Ortiz, Marcelo; Mac Courtney Christopher
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