Incidence of Deep Venous Thrombosis in Patients With COVID-19 and Pulmonary Embolism

Compression Ultrasound COVID Study

Anabel Franco‐Moreno, Maria Herrera‐Morueco, Beatriz Mestre‐Gómez, Nuria Muñoz‐Rivas, Ane Abad‐Motos, Danilo Salazar‐Chiriboga, Mercedes Duffort‐Falcó, Pilar Medrano‐Izquierdo, Ana Bustamante‐Fermosel, Virginia Pardo‐Guimera, Mariano Ulla‐Anés, Juan Torres‐Macho PhD, on behalf of the Infanta Leonor Thrombosis Research Group


Objectives: Several reports had observed a high risk of pulmonary embolism (PE) in patients with coronavirus disease 2019 (COVID‐19), most of them in the intensive care unit. Reported findings indicate that a direct viral‐mediated hyperinflammatory response leads to local thromboinflammation. According to those findings, the incidence of deep venous thrombosis (DVT) in patients with COVID‐19 and PE should be low. The objective of this study was to evaluate the incidence of DVT in patients with COVID‐19 who developed PE.

Methods: In this prospective observational study, consecutive patients hospitalized in the internal medicine ward with a diagnosis of COVID‐19 who developed PE were screened for DVT in the lower extremities with complete compression ultrasound.

Results: The study comprised 26 patients. Fifteen patients (57.7%) were male. The median age was 60 years (interquartile range, 54–73 years). Compression ultrasound findings were positive for DVT in 2 patients (7.7%; 95% confidence interval, 3.6%–11.7%). Patients with DVT had central and bilateral PE. In both, venous thromboembolism was diagnosed in the emergency department, so they did not receive previous prophylactic therapy with low‐molecular‐weight heparin. Patients without DVT had higher median d‐dimer levels: 25,688 μg/dL (interquartile range, 80,000–1210 μg/dL) versus 5310 μg/dL (P < .05).

Conclusions: Our study showed a low incidence of DVT in a cohort of patients with COVID‐19 and PE. This observation suggests that PE in these patients could be produced mainly by a local thromboinflammatory syndrome induced by severe acute respiratory syndrome coronavirus 2 infection and not by a thromboembolic event.

Keywords: compression ultrasound, coronavirus disease 2019, COVID-19, deep venous thrombosis, pulmonary embolism, thromboinflammatory syndrome respiratory syndrome.

J Ultrasound Med 2020; 9999:1–7
DOI: 10.1002/jum.15524
© 2020 American Institute of Ultrasound in Medicine