D-Dimer Elevation and Venous Thromboembolism ≥90 Days following COVID-19 A Retrospective Study within a Learning Health System
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Keywords
COVID-19, SARS-CoV-2, long COVID, venous thromboembolism, D-Dimer, learning health system
Abstract
Background: In acute COVID-19, plasma D-Dimer is a useful biomarker and venous thromboembolism (VTE) is common. However, it is less clear whether this is the case during long-term recovery.
Objectives: To report D-Dimer values and incidence of new VTE ≥90 days following COVID-19.
Methods: In British Columbia (BC), patients supported at the Post-COVID-19 Recovery Clinics underwent routine investigations including D-Dimer as part of a learning health system. Among patients with a positive D-Dimer (≥500ng/mL) test 90–180 days following COVID-19 symptom onset, we performed a retrospective chart review to determine whether imaging for VTE was done.
Results: There were 806 patients reviewed. Of these, 252 (30.3%) had a positive D-Dimer. Imaging was pursued in 56 (6.9%) and 9 (1.1%) were diagnosed with new VTE.
Interpretation: At ≥90 days post COVID-19, D-Dimer is often positive, but it is relatively rare to diagnose new VTE.
Résumé
Contexte: Dans les cas de COVID-19 aiguë, le D-dimère est un biomarqueur plasmatique utile et la thromboem-bolie veineuse (TEV) est fréquente. Toutefois, on ignore si c’est le cas au cours du rétablissement à long terme.
Objectifs: Connaître les taux plasmatiques de D-dimères et la fréquence d’une nouvelle TEV à 90 jours ou plus après avoir contracté la COVID-19.
Méthodologie: En Colombie-Britannique, les patients suivis par les cliniques de rétablissement de la COVID-19 ont subi des examens systématiques, dont le dosage des D-dimères, dans le cadre d’un système de santé apprenant. Chez les patients ayant obtenu un résultat positif au dosage des D-dimères (≥ 500 ng/mL) de 90 à 180 jours après l’apparition des symptômes de la COVID19, nous avons effectué un examen rétrospectif de leur dossier pour savoir si un examen d’imagerie pour la détection d’une TEV a été réalisé.
Résultats: Nous avons évalué 806 patients. De ce nombre, 252 (30,3 %) ont obtenu un résultat positif au dos-age des D-dimères. Un examen d’imagerie a été réalisé chez 56 patients (6,9 %) et un diagnostic de nouvelle TEV a été posé chez 9 d’entre eux (1,1 %).
Interprétation: Quatre-vingt-dix jours ou plus après avoir contracté la COVID-19, le dosage des D-dimères est souvent positif, mais le diagnostic d’une nouvelle TEV est relativement rare.
References
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Hiten Naik, University of British Columbia, Vancouver, Canada
Department of Medicine, University of British Columbia, Vancouver, Canada
Regina Li, University of British Columbia, Vancouver, Canada
Department of Medicine, University of British Columbia, Vancouver, Canada
Division of Hematology, University of British Columbia, Vancouver, Canada
Selena Shao, Provincial Health Services Authority, Vancouver, Canada
Provincial Health Services Authority, Vancouver, Canada
Krzysztof Dobosz , University of British Columbia, Vancouver, Canada
Department of Medicine, University of British Columbia, Vancouver, Canada;
Division of General Internal Medicine, University of British Columbia, Vancouver, Canada
Jesse Greiner, University of British Columbia, Vancouver, Canada
Department of Medicine, University of British Columbia, Vancouver, Canada
Division of General Internal Medicine, University of British Columbia, Vancouver, Canada
Zachary Schwartz, University of British Columbia, Vancouver, Canada
Department of Medicine, University of British Columbia, Vancouver, Canada;
Division of General Internal Medicine, University of British Columbia, Vancouver, Canada
Peter Birks, University of British Columbia, Vancouver, Canada
Department of Medicine, University of British Columbia, Vancouver, Canada
Division of Nephrology, University of British Columbia, Vancouver, Canada
Michelle Malbeuf, Provincial Health Services Authority, Vancouver, Canada
Provincial Health Services Authority, Vancouver, Canada
Karen C. Tran , University of British Columbia, Vancouver, Canada
Department of Medicine, University of British Columbia, Vancouver, Canada
Division of General Internal Medicine, University of British Columbia, Vancouver, Canada;
James A. Russell, University of British Columbia, Vancouver, Canada
Department of Medicine, University of British Columbia, Vancouver, Canada
Centre for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada
Division of Critical Care Medicine, University of British Columbia, Vancouver, Canada
Agnes Y. Y. Lee , University of British Columbia, Vancouver, Canada
Department of Medicine, University of British Columbia, Vancouver, Canada
Division of Hematology, University of British Columbia, Vancouver, Canada
Adeera Levin , University of British Columbia, Vancouver, Canada and Provincial Health Services Authority, Vancouver, Canada
Department of Medicine, University of British Columbia, Vancouver, Canada
Provincial Health Services Authority, Vancouver, Canada
Division of Nephrology, University of British Columbia, Vancouver, Canada