1
|
Houghton DE, Casanegra AI, Wysokinski WE, Padrnos LJ, Wysokinska E, Pruthi R, Heaton H, Sridharan M, McBane RD, Shah S. COVID-19 infection and risk stratification for pulmonary embolism: Identifying optimal D-dimer thresholds. Thromb Res 2024; 235:8-10. [PMID: 38245981 DOI: 10.1016/j.thromres.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/22/2023] [Accepted: 01/06/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Damon E Houghton
- Department of Cardiovascular Diseases, Division of Vascular Medicine, Rochester, MN, United States of America; Department of Internal Medicine, Division of Hematology, Mayo Clinic, MN, United States of America.
| | - Ana I Casanegra
- Department of Cardiovascular Diseases, Division of Vascular Medicine, Rochester, MN, United States of America
| | - Waldemar E Wysokinski
- Department of Cardiovascular Diseases, Division of Vascular Medicine, Rochester, MN, United States of America; Department of Internal Medicine, Division of Hematology, Mayo Clinic, MN, United States of America
| | - Leslie J Padrnos
- Department of Internal Medicine, Division of Hematology/Oncology, Mayo Clinic, AZ, United States of America
| | - Ewa Wysokinska
- Department of Internal Medicine, Division of Hematology/Oncology, Mayo Clinic, FL, United States of America
| | - Rajiv Pruthi
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, MN, United States of America
| | - Heather Heaton
- Department of Emergency Medicine, Mayo Clinic, MN, United States of America
| | - Meera Sridharan
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, MN, United States of America
| | - Robert D McBane
- Department of Cardiovascular Diseases, Division of Vascular Medicine, Rochester, MN, United States of America; Department of Internal Medicine, Division of Hematology, Mayo Clinic, MN, United States of America
| | - Surbhi Shah
- Department of Internal Medicine, Division of Hematology/Oncology, Mayo Clinic, AZ, United States of America
| |
Collapse
|
2
|
Ena J, Valls V. Therapeutic-dose anticoagulation or thromboprophylaxis with low-molecular-weight heparin for moderate Covid-19: meta-analysis of randomized controlled trials. Clin Exp Med 2023; 23:1189-1196. [PMID: 36048371 PMCID: PMC9435420 DOI: 10.1007/s10238-022-00876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND We carried out a meta-analysis since there is not enough evidence to recommend for or against therapeutic-dose anticoagulation compared with thromboprophylaxis in noncritically ill patients hospitalized with Covid-19. METHODS We performed a systematic literature search using PubMed, Embase, Cochrane Library, and MedRxiv for randomized trials that included therapeutic-dose with low-molecular-weight heparin (LMW) or thromboprophylaxis with LMW heparin in noncritically ill patients admitted to the hospital with Covid-19. We identified five open-label studies for analysis with a total of 3220 patients. Two independent researchers selected, assessed, and extracted the data in duplicate. The outcomes evaluated were all-cause mortality, progression to invasive mechanical ventilation, incidence of venous thromboembolism, and major bleeding. The studies did not show risk for selection, detection, attrition, or reporting bias. RESULTS Therapeutic-dose anticoagulation with LMW heparin compared with thromboprophylaxis with LMW heparin had no significant effect of all-cause death (risk ratio [RR] 0.85; 95% confidence interval [CI] 0.67-1.07; P = 0.16; I2 = 48%), or progression to invasive mechanical ventilation (RR 0.89; CI 0.73-1.08; P = 0.24; I2: 0%). Therapeutic-dose anticoagulation significantly reduced the risk of venous thromboembolic disease (RR 0.42; 95% CI 0.28-0.62; P = 0.0001; I2 = 0%) [Number needed to treat = 37]. Major bleeding occurred in 1.79% of the patients receiving therapeutic-dose anticoagulation and in 0.97% of those receiving thromboprophylaxis [Number needed to harm 125]. CONCLUSION Therapeutic-dose anticoagulation in noncritically ill patients with Covid-19 could be indicated for patients at high risk of venous thromboembolic disease and low risk of bleeding.
Collapse
Affiliation(s)
- Javier Ena
- Servicio de Medicina Interna, Department of Internal Medicine, Hospital Marina Baixa, Av Jaime Botella Mayor, 7, 03570, Villajoyosa, Alicante, Spain.
| | - Victoria Valls
- Department of Public Health, University Miguel Hernandez, Alicante, Spain
| |
Collapse
|
3
|
Bledsoe JR, Knox D, Peltan ID, Woller SC, Lloyd JF, Snow GL, Horne BD, Connors JM, Kline JA. D-dimer Thresholds to Exclude Pulmonary Embolism among COVID-19 Patients in the Emergency Department: Derivation with Independent Validation. Clin Appl Thromb Hemost 2022; 28:10760296221117997. [PMID: 35942703 PMCID: PMC9373165 DOI: 10.1177/10760296221117997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To derive and validate a D-dimer cutoff for ruling out pulmonary embolism
(PE) in COVID-19 patients presenting to the emergency department (ED). Methods A retrospective cohort study was performed in an integrated healthcare system
including 22 adult ED's between March 1, 2020, and January 31, 2021. Results
were validated among patients enrolled in the RECOVER Registry, representing
data from 154 ED's from 26 US states. Consecutive ED patients with
laboratory confirmed COVID-19, a D-dimer performed within 48 h of ED
arrival, and with objectively confirmed PE were compared to those without
PE. After identifying a D-dimer threshold at which the 95% confidence lower
bound of the negative predictive value for PE was higher than 98% in the
derivation cohort, it was validated using RECOVER registry data. Results Among 3978 patients with a D-dimer result, 3583 with confirmed COVID-19
infection were included in the derivation cohort. Overall, PE incidence was
4.1% and a D-dimer cutoff of <2 μ/mL (2000 ng/mL)
was associated with a NPV of 98.5% (95% CI = 98.0%−98.9%). In the validation
cohort of 13,091 patients with a D-dimer, 7748 had confirmed COVID-19
infection, and the PE incidence was 1.14%. A D-dimer cutoff of
<2 μ/mL was associated with a NPV of 99.5%
(95% CI = 99.3%−99.7%). Conclusion A D-dimer cutoff of <2 μ/ml was associated with a
high negative predictive value for PE among patients with COVID-19. However,
the resultant sensitivity for PE result at that threshold without pre-test
probability assessment would be considered clinically unsafe.
Collapse
Affiliation(s)
- Joseph R Bledsoe
- Department of Emergency Medicine, Intermountain Healthcare, Salt Lake City, UT, USA.,Department of Emergency Medicine, 158423Stanford Medicine, Stanford, CA, USA
| | - Daniel Knox
- Department of Medicine, Division of Pulmonary/Critical Care, Intermountain Medical Center and University of Utah, Salt Lake City, UT, USA
| | - Ithan D Peltan
- Department of Medicine, Division of Pulmonary/Critical Care, Intermountain Medical Center and University of Utah, Salt Lake City, UT, USA
| | - Scott C Woller
- Department of Internal Medicine, Intermountain Medical Center Department of Medicine and University of Utah, Salt Lake City, UT, USA
| | - James F Lloyd
- Medical Informatics and Analytics, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Gregory L Snow
- Intermountain Healthcare, Office of Research, Statistical Data Center, Salt Lake City, UT, USA
| | - Benjamin D Horne
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Jean M Connors
- Department of Hematology, Brigham and Womens Hospital, Boston, MA, USA
| | - Jeffrey A Kline
- Department of Emergency Medicine, 12267Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|