key: cord-0772250-nnhwgtd9 authors: Zermatten, Maxime G.; Pantet, Olivier; Gomez, Francisco; Schneider, Antoine; Méan, Marie; Mazzolai, Lucia; Hugli, Olivier; Bart, Pierre-Alexandre; Papadimitriou-Olivgeris, Matthaios; Alberio, Lorenzo title: Utility of D-dimers and intermediate-dose prophylaxis for venous thromboembolism in critically ill patients with COVID-19 date: 2020-08-21 journal: Thromb Res DOI: 10.1016/j.thromres.2020.08.027 sha: bad9918b8f2ab88db676ac738a9bc261ae18c0b7 doc_id: 772250 cord_uid: nnhwgtd9 nan Increasing evidence indicates that hypercoagulability plays a significant role in the pathophysiology of severe coronavirus disease 2019 (COVID-19), contributing to macro-and microvascular thrombosis (1, 2) . It is of practical relevance to identify adequate diagnostic and prophylactic approaches to recognize and limit these complications. We report D-dimer performance in VTE-diagnosis and the comparison of intermediate-dose versus standard-of-care prophylactic anticoagulation in VTEprevention among critically-ill COVID-19 patients. We performed a retrospective study at Lausanne University Hospital (CHUV 03.08.2020 3 day 1 of hospitalisation were considered as prehospital-acquired; the others as hospital-acquired. VTE until 9 April 2020 were considered related to standard-of-care prophylactic anticoagulation. The significance level was set at 0.05. Qualitative variables were compared using Fisher's exact and Chi-square tests, and continuous variables using Mann-Whitney test. From 4 Figures 1B and 1C show the VTE-/ATE-cumulative proportions. The VTE-incidence was 5% at patients. Our study has limitations. First, D-dimer analyses was performed during periods with standard-ofcare and intermediate-dose prophylactic anticoagulation. Because only three VTE were diagnosed in the second phase, it was impossible to perform separate analyses. Second, this is a retrospective, mono-centric study limiting its generalisation. Third, VTE/ATE-imaging were performed according to clinical judgement and VTE-incidence is likely underestimated. However, since during the second period the awareness of the thromboembolic risk in COVID-19 was higher, the reduction of VTEincidence observed is even more robust. Fourth, the SARS-CoV-2 epidemics was ongoing at time of data analysis and eight patients were still in ICU. Five, follow-up was shorter than three months, which is the standard for the absence of hospital-acquired VTE. In conclusion, critically-ill COVID-19 patients are at high VTE-risk. Physicians should keep a high suspicion for thromboembolism during the whole hospitalisation. An intermediate-dose prophylactic anticoagulation appears to reduce their incidence. D-dimer cut-offs of 2'000 ng/ml and 8'000 ng/ml appear useful to identify patients with low, respectively high probability of having developed VTE. Our findings need to be confirmed in prospective studies. J o u r n a l P r e -p r o o f The authors do not have competing interest to declare in relation to this manuscript No external funding. MGZ designed the study, collected data, performed statistical analysis, analysed and interpreted data, and wrote the manuscript. OP designed the study, was in charge of patient care, collected data, participated in data validation, and revised the manuscript. FG collected data, and revised the manuscript. AS was in charge of patient care, collected data, and revised the manuscript. MM analysed and interpreted data, and revised the manuscript. LM analysed and interpreted data, and revised the manuscript. OH analysed and interpreted data, and revised the manuscript. PAB analysed and interpreted data, and revised the manuscript. MPO analysed and interpreted data, and revised J o u r n a l P r e -p r o o f the manuscript. LA designed the study, analysed and interpreted data, participated in data validation, and wrote the manuscript All authors read and approved the submitted version of the manuscript. Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study Subcommittee on Control of Anticoagulation of the S, Standardization Committee of the International Society on T, Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia VTE Incidence and Risk Factors in Patients With Severe Sepsis and Septic Shock Reduction in deep vein thrombosis incidence in intensive care after a clinician education program The cumulative venous thromboembolism incidence and risk factors in intensive care patients receiving the guideline-recommended thromboprophylaxis Failure of chemical thromboprophylaxis in critically ill medical and surgical patients with sepsis Acute Pulmonary Embolism in COVID-19 Patients on CT Angiography and Relationship to D-Dimer Levels D-dimers Are a Predictor of Clot Volume Inside Membrane Oxygenators During Extracorporeal Membrane Oxygenation