Upper extremity DVT common in COVID-19 despite proper prophylaxis

About 10 percent of patients with the coronavirus disease 2019 (COVID-19) will suffer from upper extremity deep vein thrombosis (UEDVT) despite adequate prophylaxis, a recent study has found.

Researchers conducted a retrospective analysis of 257 patients (mean age 70.14 years, 70.0 percent men) who had moderate-to-severe COVID-19. As per standard protocol, vein compression ultrasonography was performed for the systematic screening for UEDVT. All patients had received pharmacological thromboprophylaxis in accordance with international guidelines.

Most (97.28 percent) of the patients had at least one comorbidity, the most common of which was hypertension. Helmet continuous positive airway pressure (CPAP) was applied to 63.8 percent of the patients for a median duration of 9 days.

By the end of the data collection, 76.0 percent of patients had been discharged, 20.7 percent had died, 1.5 percent had been transferred to another hospital, and 1.2 percent remained hospitalized.

Twenty-eight patients developed UEDVT, yielding an incidence rate of 10.9 percent; ten of these patients also had concomitant lower extremity DVT.

UEDVT arose significantly more frequently among patients with severe COVID-19, due to their lower ratio of arterial partial pressure of oxygen to the fraction of inspired oxygen (212.77 vs 251.35; p<0.05), higher incidence of pneumonia (96.4 percent vs 79.7 percent; p<0.05), and higher likelihood of meeting the diagnostic criteria for acute respiratory distress syndrome (75.0 percent vs 43.8 percent; p<0.001).

UEDVT patients likewise had a significantly greater need for CPAP (92.9 percent vs 60.3 percent; p<0.0001). Mortality was also higher in UEDVT patients (46.4 percent vs 17.5 percent; p<0.01).

However, multivariate regression analysis found helmet CPAP ventilation (odds ratio [OR], 5.95, 95 percent confidence interval [CI], 1.33–26.58) and D-dimer levels above the age-adjusted range (OR, 8.20, 95 percent CI, 2.94–22.89) to be the only significant and independent correlates of UEDVT.

“COVID-19 patients requiring CPAP showed a high risk of UEDVT; nevertheless, further investigation is required to evaluate the risk/benefit of an intermediate dose of heparin in these patients,” the researchers said.