Deep Vein Thrombosis and Pulmonary Embolism: Two Complicatio
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Deep vein thrombosis and pulmonary embolism can occur in patients with COVID-19 pneumonia. Low-molecular-weight heparin prophylaxis does not decrease the risk of venous thromboembolism (VTE) in COVID-19 pneumonia. In the presence of clinical signs and/or suspicion of VTE, compression ultrasound and echocardiography should be always performed, irrespective of disease stage.

Coronavirus disease 19 (COVID-19) is a worldwide infection which was recently declared a global health emergency by the WHO Emergency Committee. The most common symptoms are fever and cough, which can progress to pneumonia, acute respiratory distress syndrome (ARDS) and/or end-organ failure. Risk factors associated with ARDS and death are older age, comorbidities (e.g., hypertension, diabetes, hyperlipidaemia), neutrophilia, and organ and coagulation dysfunction. Disseminated intravascular coagulation and coagulopathy can contribute to death. Anticoagulant treatment is associated with decreased mortality in severe COVID-19 pneumonia. This report describes two patients with COVID-19 pneumonia who developed venous thromboembolism.

VTE is a significant cause of morbidity and mortality. Risk factors include older age, immobilization, obesity, smoking and hospitalization. COVID-19 patients frequently complain of severe asthenia, fatigue and consequent inactivity, even at the beginning of the infection. In addition, risk factors for VTE include hypoxia and sepsis, which are two common features of COVID-19. Anticoagulant treatment is associated with decreased mortality in severe COVID-19 pneumonia <7sup>, but no data have been reported in the literature for the different stages of COVID-19 infection.

Furthermore, D-dimer is not a useful marker for diagnosing VTE in COVID-19, because it is generally increased, particularly in severe COVID-19 pneumonia, and is associated with the development of ARDS and progression from ARDS to death. Based on all this evidence, if there are clinical signs and/or suspicion of VTE, CUS and echocardiography should always be performed, irrespective of disease stage. Our findings suggest that patients with COVID-19 pneumonia should be investigated for VTE even if treated with LMWH. Both our patients seemed to be at risk of VTE even in the absence of hypoxaemia and severe respiratory failure, and it is clear VTE can increase the risk of death in COVID-19 patients.

Source: https://www.ejcrim.com/index.php/EJCRIM/article/view/1646/2039
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Dr. V●●●●●●j D●●●i Legal Medicine
Is it not a fact that chances of DVT & pulmonary embolism increase with any condition of the patient where there is prolonged immobilization? Established medical principle. Scope/role of limited physiotherapy in such conditions for prevention of DVT & PE !!!
Apr 22, 2020Like