D-Dimer Levels Alone Not Enough to Initiate Anticoagulation in Hospitalised Patients With COVID-19

November 20, 2020

By Eric Ramos

CHICAGO -- November 19, 2020 -- Deep venous thrombosis (DVT) was frequently diagnosed in patients hospitalised with coronavirus disease 2019 (COVID-19) who underwent imaging due to elevated D-Dimer levels; however, there was considerable overlap of peak D-Dimer values
in patients with and without documented DVT, according to a study presented at the Virtual 2020 American Heart Association (AHA) Scientific Sessions.

“Many institutional algorithms and ongoing studies suggest using D-Dimer cut-offs to initiate anticoagulation,” said Mahesh V. Madhavan, MD, Columbia University Medical Center, New York, New York. “However, the relationship between D-Dimer levels and deep venous thrombosis has not been extensively studied specifically in patients with COVID-19.”

For the study, the researchers analysed data from 2,677 patients hospitalised at Columbia University Medical Center with laboratory-confirmed COVID-19 between February 1, 2020, and May 19, 2020. Of the patients, 514 underwent lower extremity venous doppler imaging, and 186 (36.2%) were diagnosed with DVT.

Baseline characteristics and vital signs were similar between patients with and without DVT, except for a history of cancer, which was significantly more common in patients with DVT (14.7% vs 6.3%; P

The upper limit D-Dimer value for the hospital’s laboratory assay was >20 mg/dL. Median peak D-Dimer levels were 18.5 mg/dL (IQR, 6.4-20.0 mg/dL) among patients with DVT compared with 12.2 mg/dL (IQR, 3.7-2.0 mg/dL) among patients without DVT -- a difference that was not statistically significant (P = .80).

Density plots of initial D-Dimer values grouped by presence of DVT showed that there was considerable overlap of peak D-Dimer values in patients with and without documented DVT.

“Elevation in D-Dimer values alone should not prompt routine initiation of therapeutic anticoagulation in hospitalised patients with COVID-19,” said Dr. Madhavan. “Data from prospective clinical trials and registries regarding optimal antithrombotic practices in this patient population is needed.”

[Presentation title: The Relationship Between D-Dimer Levels and Deep Venous Thrombosis in COVID-19: an Analysis From a Quaternary Academic Medical Center in New York City. Abstract 394]