Abstract Number: PB/CO19
Meeting: ISTH 2020 Congress
Background: Elevated d-dimers in COVID-19 patients are associated with poor prognosis and increased mortality. However, they have not been used consistently to identify patients for evaluation of concurrent pulmonary artery thrombosis (PAT).
Aims: To evaluate the prevalence of PAT in COVID-19 patients attending the emergency department (ED), and investigate d-dimer cut-offs for diagnosis through computed tomography pulmonary angiogram (CTPA).
Methods: This retrospective review included 685 COVID-19 positive patients. D-dimers were performed in 512 patients, 89 had CTPA, and 82 had both within 48 hrs of admission.
Results: PAT was detected in 42% (37/89) of patients who had a CTPA within 48hrs of admission. In the group with CTPA and d-dimers (n=82) receiver operator characteristic analysis demonstrated that d-dimers were good for predicting PAT (AUC of 0.78, P< 0.0001). A d-dimer cut-off of 2000 ng/mL had a 87.5% sensitivity, with 83.3% negative predictive value for PAT detection. In this group, 71% of patients had a d-dimer >2000 ng/mL with almost half of them having a positive scan. Implementing this cut-off across the cohort with d-dimer results only (n=430) would require nearly a third of the COVID-19 patients to have CTPA.
Conclusions: Our data suggest a significant prevalence of PAT in patients with COVID-19 at initial presentation. Due to the significant overlap of the clinical syndrome of COVID-19 with that of PAT, it is difficult to select patients for CTPA based on the clinical presentation alone. Locally agreed d-dimer cut-offs can be used to guide the need for CTPA.
To cite this abstract in AMA style:Perera A, Chowdary P, Johnson J, Lamb L, Drebes A, Mir N, Sood T. Elevated D-dimers Useful Prediction of Pulmonary Artery Thrombosis in COVID-19 Patients at Initial Presentation to Hospital [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/elevated-d-dimers-useful-prediction-of-pulmonary-artery-thrombosis-in-covid-19-patients-at-initial-presentation-to-hospital/. Accessed January 23, 2022.
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