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Upper Extremity DVT Prevalent in COVID-19 Patients

Despite appropriate prophylaxis, upper extremity DVT is prevalent in COVID-19.

Upper Extremity DVT Prevalent in COVID-19 Patients
Image: COVID-19 Patient | InStyleHealth

According to a recent study, over 10% of individuals with the coronavirus disease 2019 (COVID-19) would develop upper extremity deep vein thrombosis (UEDVT) despite effective prophylaxis.

A retrospective examination of 257 individuals with moderate-to-severe COVID-19 (mean age 70.14 years, 70.0 percent men) was done. Vein compression ultrasonography was used to screen for UEDVT in accordance with established practice. According to international norms, all patients were given pharmaceutical thromboprophylaxis.

The majority of the patients (97.28 percent) had at least one comorbidity, with hypertension being the most frequent. 63.8 percent of the patients received helmet continuous positive airway pressure (CPAP) for a median of 9 days.

76.0 percent of patients were discharged, 20.7 percent died, 1.5 percent were moved to another hospital, and 1.2 percent remained in the hospital at the end of the data collection.

Twenty-eight individuals developed UEDVT, for a 10.9 percent incidence rate; ten of these patients also had lower extremity DVT.

Because of their lower ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (212.77 vs 251.35; p0.05), higher incidence of pneumonia (96.4 percent vs 79.7%; p0.05), and higher likelihood of meeting the diagnostic criteria for acute respiratory distress syndrome (75.0 percent vs 43.8 percent; p0.001), patients with severe COVID-19 developed UEDVT significantly more frequently.

Patients with UEDVT required considerably more CPAP (92.9 percent vs 60.3 percent; p0.0001). UEDVT patients also had a greater mortality rate (46.4 percent vs 17.5 percent; p0.01).

Moreover, multivariate regression analysis revealed that helmet CPAP ventilation (OR: 5.95, 95 percent confidence interval: 1.33–26.58) and D-dimer levels beyond the age-adjusted range (OR: 8.20, 95 percent confidence interval: 2.94–22.89) were the only significant and independent correlates of UEDVT.

"While COVID-19 patients who used CPAP had a significant risk of UEDVT, more study is needed to assess the risk/benefit of an intermediate dose of heparin in these individuals," the researchers wrote.

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