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 Thrombosis Research 190 (2020) 102
Contents lists available at ScienceDirect
Thrombosis Research
journal homepage: www.elsevier.com/locate/thromres
Letter to the Editors-in-Chief
Age-adjusted D-dimer cut-off levels to rule out venous thromboembolism in COVID-19 patients
ARTICLE INFO
Keywords:
Venous thromboembolism
COVID-19
D-dimer
We read with great interest the manuscript published by Klok and
colleagues which highlight important aspects regarding the occurrence
of venous thromboembolism (VTE) in patients with COVID-19 infec-
tions hospitalized in intensive care unit (ICU) [1]. The investigation
reported a higher risk of thrombotic complications in COVID-patients
with severe disease hospitalized in ICU. Notably, age-adjusted hazard
ratio and coagulopathy, defined, as spontaneous prolongation of the
prothrombin time > 3 s or activated partial thromboplastin time > 5 s
resulted independent predictors of thrombotic complications. Re-
garding the venous thrombotic events, no data regarding which type of
clinical pre-test probability was used to suspect VTE. Moreover, no data
regarding the D-dimer level assessment were provided. It would be of
interest to know if the D-dimer level was evaluated using a fix or an age
adjusted cut-off. Indeed, as reported by other recent investigations and
national surveillance programs, the mortality rate as well as the severe
forms of COVID-19 pneumonia increase with aging [2]. For these rea-
sons, it seems reasonable to prefer the adoption of an age-adjusted cut-
off in these subjects. Moreover, it has already been demonstrated by
several studies and meta-analysis that the age-adjusted threshold can
reduce the need for imaging tests compared to a fixed cut-off [3–8].
This aspect could be very useful in COVID-19 subjects, limiting the need
for CUS and/or to transfer an infectious patient to the radiology ward to
perform an unnecessary computed tomography pulmonary angio-
graphy (CTPA) to exclude PE. Further studies are needed to assess the
clinical features and prognostic implications of VTE in COVID-19 pa-
tients to further improve their thromboprophylaxis and diagnostic
management. However, the VTE is emerging as an important compli-
cation in COVID-19 patients that must be not underestimated.
Funding
None.
Declaration of competing interest
None of the authors have conflicts of interest to declare.
⁎
Corresponding author at: Department of Cardiology, Rovigo General Hospital, Viale tre Martiri, Rovigo 45100, Italy.
https://doi.org/10.1016/j.thromres.2020.04.021
Received 13 April 2020; Accepted 16 April 2020
Available online 21 April 2020
0049-3848/ © 2020 Elsevier Ltd. All rights reserved.
T
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Loris Roncona, , Marco Zuina,b, Pietro Zonzina
⁎
a
Department of Cardiology, Santa Maria della Misericordia Hospital,
Rovigo, Italy
b
University of Ferrara, School of Medicine, Ferrara, Italy
E-mail address: loris.roncon@aulss5.veneto.it (L. Roncon).