Evaluation of Serial Ultrasound Screening in ICU COVID-19 Patients

NCT ID: NCT05028244

Last Updated: 2024-04-10

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 168 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-04-01
• Study Completion Date: 2021-12-13

Brief Summary

This clinical trial is designed to evaluate if the periodic screening for deep venous thrombosis by ultrasound of lower extremity in patients with intensive care unit (ICU) patients with COVID 19 impacts on mortality, ICU stay and total length of stay in the hospital, along with other outcomes.

Detailed Description

Background: COVID-19 has a high incidence of venous thromboembolic disease (VTE), especially pulmonary thromboembolism (PE) and deep vein thrombosis (DVT), with an even higher incidence in patients admitted to the intensive care unit (ICU). The presentation of these events is related to an increase in mortality and the mean stay in the ICU. The impact of systematic screening for asymptomatic lower extremity DVT in these patients has not been studied, so we propose to carry out a clinical trial to assess its impact in these patients.

Hypothesis: Serial DVT screening in patients admitted to the ICU for COVID-19 does not improve survival, mean stay, or the incidence of symptomatic VTE.

Objective: To study whether DVT screening in these patients has an impact on the incidence of symptomatic VTE, mortality and average stay in the ICU.

Methods: Non-blind randomized clinical trial on all patients aged 18 years or older admitted to the ICU for COVID-19 with less than 72 hours elapsed since their admission to the unit. Patients with DVT or PE will be excluded at the time of recruitment (all patients will be ruled out by routine ultrasound and computed tomography angiography (CT Angiography)); Pregnant patients, patients with a previous diagnosis of DVT or PE, and patients undergoing extracorporeal membrane oxygenation (ECMO) will also be excluded. Patients will be randomized into two arms at the time of inclusion: the screened group (Group 1) and the non-screened group (Group 2). Group 1: patients who will be treated according to the usual ICU protocol and, additionally, will undergo serial ultrasounds of the lower extremities twice a week (Monday and Thursday). Group 2: they will be treated according to the usual ICU protocol and no screening examinations will be performed. Patients will be followed until discharge from the ICU or death and up to a maximum of 3 weeks. The incidence of symptomatic VTE will be assessed, as well as all-cause mortality and days of stay in the ICU. Clinical and laboratory variables will be collected from each patient for subsequent statistical analysis.

Relevance: The thrombotic complications of COVID-19 are well described, as well as their high incidence in critically ill patients. This work aims to clarify the current doubts about the need for systematic DVT screening in these patients. If our hypothesis is verified, a limited resource such as ultrasound of the lower limbs could be saved, as well as the use of the necessary protection materials and, most importantly, avoid unnecessary exposure of health personnel with the consequent risk that it represents for other professionals and patients.

Conditions

Deep Vein Thrombosis; Covid19; COVID-19 Pneumonia; COVID-19 Respiratory Infection; COVID-19 Acute Respiratory Distress Syndrome; COVID-19 Acute Bronchitis; COVID-19 Lower Respiratory Infection; Pulmonary Embolism

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

Intervention group

Selected patients undergo lower extremity ultrasound for diagnosis of deep vein thrombosis 2 times per week (Mondays and Thursdays) in a period of 3 weeks (21 days) of follow up

Group Type: EXPERIMENTAL

venous ultrasound of lower extremity

Intervention Type: DIAGNOSTIC_TEST

Patients are explored for deep vein thrombosis in femoral-popliteal and distal veins of the legs with ultrasound compression and doppler flow evaluation

control group

This group only undergo the first ultrasound assessment to discard previous thrombosis not detected during hospitalisation or ambulatory

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

venous ultrasound of lower extremity

Patients are explored for deep vein thrombosis in femoral-popliteal and distal veins of the legs with ultrasound compression and doppler flow evaluation

Intervention Type: DIAGNOSTIC_TEST

Eligibility Criteria

Inclusion Criteria

• COVID 19 patients in their first 72 hours of entering ICU

Exclusion Criteria

• Pregnant patients
• Not COVID 19 confirmed patients by RCP
• Patients that are in Extracorporeal membrane oxygenation
• Patients with previous thrombotic disease

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Universitat Autonoma de Barcelona

OTHER

Sponsor Role: collaborator

Hospital Universitari Vall d'Hebron Research Institute

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Sergi Bellmunt Montoya

Role: PRINCIPAL_INVESTIGATOR

Hospital Vall d'Hebron

Locations

Hospital Universitari Vall d'Hebron

Barcelona, , Spain

Countries

Spain

References

Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L, Clement C, Robinson KS, Lewandowski B. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997 Dec 20-27;350(9094):1795-8. doi: 10.1016/S0140-6736(97)08140-3.

Reference Type: BACKGROUND

PMID: 9428249 (View on PubMed)

Jenner WJ, Kanji R, Mirsadraee S, Gue YX, Price S, Prasad S, Gorog DA. Thrombotic complications in 2928 patients with COVID-19 treated in intensive care: a systematic review. J Thromb Thrombolysis. 2021 Apr;51(3):595-607. doi: 10.1007/s11239-021-02394-7. Epub 2021 Feb 14.

Reference Type: BACKGROUND

PMID: 33586113 (View on PubMed)

Mohamed MFH, Al-Shokri SD, Shunnar KM, Mohamed SF, Najim MS, Ibrahim SI, Elewa H, Abdalla LO, El-Bardissy A, Elshafei MN, Abubeker IY, Danjuma M, Dousa KM, Yassin MA. Prevalence of Venous Thromboembolism in Critically Ill COVID-19 Patients: Systematic Review and Meta-Analysis. Front Cardiovasc Med. 2021 Jan 8;7:598846. doi: 10.3389/fcvm.2020.598846. eCollection 2020.

Reference Type: BACKGROUND

PMID: 33585578 (View on PubMed)

Flumignan RL, Civile VT, Tinoco JDS, Pascoal PI, Areias LL, Matar CF, Tendal B, Trevisani VF, Atallah AN, Nakano LC. Anticoagulants for people hospitalised with COVID-19. Cochrane Database Syst Rev. 2022 Mar 4;3(3):CD013739. doi: 10.1002/14651858.CD013739.pub2.

Reference Type: BACKGROUND

PMID: 35244208 (View on PubMed)

Sebuhyan M, Mirailles R, Crichi B, Frere C, Bonnin P, Bergeron-Lafaurie A, Denis B, Liegeon G, Peyrony O, Farge D; Saint-Louis CORE (COVID-19 RESEARCH) group. How to screen and diagnose deep venous thrombosis (DVT) in patients hospitalized for or suspected of COVID-19 infection, outside the intensive care units. J Med Vasc. 2020 Dec;45(6):334-343. doi: 10.1016/j.jdmv.2020.08.002. Epub 2020 Sep 4.

Reference Type: BACKGROUND

PMID: 33248536 (View on PubMed)

Boonyawat K, Chantrathammachart P, Numthavaj P, Nanthatanti N, Phusanti S, Phuphuakrat A, Niparuck P, Angchaisuksiri P. Incidence of thromboembolism in patients with COVID-19: a systematic review and meta-analysis. Thromb J. 2020 Nov 23;18(1):34. doi: 10.1186/s12959-020-00248-5.

Reference Type: BACKGROUND

PMID: 33292258 (View on PubMed)

Jimenez D, Garcia-Sanchez A, Rali P, Muriel A, Bikdeli B, Ruiz-Artacho P, Le Mao R, Rodriguez C, Hunt BJ, Monreal M. Incidence of VTE and Bleeding Among Hospitalized Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis. Chest. 2021 Mar;159(3):1182-1196. doi: 10.1016/j.chest.2020.11.005. Epub 2020 Nov 17.

Reference Type: BACKGROUND

PMID: 33217420 (View on PubMed)

Suh YJ, Hong H, Ohana M, Bompard F, Revel MP, Valle C, Gervaise A, Poissy J, Susen S, Hekimian G, Artifoni M, Periard D, Contou D, Delaloye J, Sanchez B, Fang C, Garzillo G, Robbie H, Yoon SH. Pulmonary Embolism and Deep Vein Thrombosis in COVID-19: A Systematic Review and Meta-Analysis. Radiology. 2021 Feb;298(2):E70-E80. doi: 10.1148/radiol.2020203557. Epub 2020 Dec 15.

Reference Type: BACKGROUND

PMID: 33320063 (View on PubMed)

Bohula EA, Berg DD, Lopes MS, Connors JM, Babar I, Barnett CF, Chaudhry SP, Chopra A, Ginete W, Ieong MH, Katz JN, Kim EY, Kuder JF, Mazza E, McLean D, Mosier JM, Moskowitz A, Murphy SA, O'Donoghue ML, Park JG, Prasad R, Ruff CT, Shahrour MN, Sinha SS, Wiviott SD, Van Diepen S, Zainea M, Baird-Zars V, Sabatine MS, Morrow DA; COVID-PACT Investigators. Anticoagulation and Antiplatelet Therapy for Prevention of Venous and Arterial Thrombotic Events in Critically Ill Patients With COVID-19: COVID-PACT. Circulation. 2022 Nov;146(18):1344-1356. doi: 10.1161/CIRCULATIONAHA.122.061533. Epub 2022 Aug 29.

Reference Type: BACKGROUND

PMID: 36036760 (View on PubMed)

Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers D, Kant KM, Kaptein FHJ, van Paassen J, Stals MAM, Huisman MV, Endeman H. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thromb Res. 2020 Jul;191:148-150. doi: 10.1016/j.thromres.2020.04.041. Epub 2020 Apr 30.

Reference Type: BACKGROUND

PMID: 32381264 (View on PubMed)

Gil-Sala D, Riera C, Garcia-Reyes M, Rodriguez M, Marrero CE, Martinez L, Gil M, Ruiz-Rodriguez JC, Ferrer R, DE Nadal M, Suito-Alcantara MA, Llagostera S, Bellmunt-Montoya S. Mortality and bleeding complications of COVID-19 critically ill patients with venous thromboembolism. Int Angiol. 2022 Feb;41(1):1-8. doi: 10.23736/S0392-9590.21.04704-0. Epub 2021 Nov 9.

Reference Type: BACKGROUND

PMID: 34751541 (View on PubMed)

Mansory EM, Srigunapalan S, Lazo-Langner A. Venous Thromboembolism in Hospitalized Critical and Noncritical COVID-19 Patients: A Systematic Review and Meta-analysis. TH Open. 2021 Jul 6;5(3):e286-e294. doi: 10.1055/s-0041-1730967. eCollection 2021 Jul.

Reference Type: BACKGROUND

PMID: 34240001 (View on PubMed)

Xiao D, Tang F, Chen L, Gao H, Li X. Cumulative Evidence for the Association of Thrombosis and the Prognosis of COVID-19: Systematic Review and Meta-Analysis. Front Cardiovasc Med. 2022 Jan 25;8:819318. doi: 10.3389/fcvm.2021.819318. eCollection 2021.

Reference Type: BACKGROUND

PMID: 35146009 (View on PubMed)

Mazzaccaro D, Giannetta M, Fancoli F, Milani V, Modafferi A, Malacrida G, Righini P, Marrocco-Trischitta MM, Nano G. COVID and venous thrombosis: systematic review of literature. J Cardiovasc Surg (Torino). 2021 Dec;62(6):548-557. doi: 10.23736/S0021-9509.21.12022-1. Epub 2021 Sep 14.

Reference Type: BACKGROUND

PMID: 34520137 (View on PubMed)

Kollias A, Kyriakoulis KG, Lagou S, Kontopantelis E, Stergiou GS, Syrigos K. Venous thromboembolism in COVID-19: A systematic review and meta-analysis. Vasc Med. 2021 Aug;26(4):415-425. doi: 10.1177/1358863X21995566. Epub 2021 Apr 4.

Reference Type: BACKGROUND

PMID: 33818197 (View on PubMed)

Tufano A, Rendina D, Abate V, Casoria A, Marra A, Buonanno P, Galletti F, Di Minno G, Servillo G, Vargas M. Venous Thromboembolism in COVID-19 Compared to Non-COVID-19 Cohorts: A Systematic Review with Meta-Analysis. J Clin Med. 2021 Oct 25;10(21):4925. doi: 10.3390/jcm10214925.

Reference Type: BACKGROUND

PMID: 34768445 (View on PubMed)

Malas MB, Naazie IN, Elsayed N, Mathlouthi A, Marmor R, Clary B. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis. EClinicalMedicine. 2020 Dec;29:100639. doi: 10.1016/j.eclinm.2020.100639. Epub 2020 Nov 20.

Reference Type: BACKGROUND

PMID: 33251499 (View on PubMed)

Zhang R, Ni L, Di X, Wang X, Ma B, Niu S, Liu C. Systematic review and meta-analysis of the prevalence of venous thromboembolic events in novel coronavirus disease-2019 patients. J Vasc Surg Venous Lymphat Disord. 2021 Mar;9(2):289-298.e5. doi: 10.1016/j.jvsv.2020.11.023. Epub 2020 Dec 9.

Reference Type: BACKGROUND

PMID: 33309903 (View on PubMed)

Reis S, Popp M, Schmid B, Stegemann M, Metzendorf MI, Kranke P, Meybohm P, Weibel S. Safety and Efficacy of Intermediate- and Therapeutic-Dose Anticoagulation for Hospitalised Patients with COVID-19: A Systematic Review and Meta-Analysis. J Clin Med. 2021 Dec 23;11(1):57. doi: 10.3390/jcm11010057.

Reference Type: BACKGROUND

PMID: 35011804 (View on PubMed)

Moonla C, Sosothikul D, Chiasakul T, Rojnuckarin P, Uaprasert N. Anticoagulation and In-Hospital Mortality From Coronavirus Disease 2019: A Systematic Review and Meta-Analysis. Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211008999. doi: 10.1177/10760296211008999.

Reference Type: BACKGROUND

PMID: 33874753 (View on PubMed)

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020 Apr;18(4):844-847. doi: 10.1111/jth.14768. Epub 2020 Mar 13.

Reference Type: BACKGROUND

PMID: 32073213 (View on PubMed)

Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020 Jun;18(6):1421-1424. doi: 10.1111/jth.14830. Epub 2020 May 6.

Reference Type: BACKGROUND

PMID: 32271988 (View on PubMed)

Bellmunt-Montoya S, Riera C, Gil D, Rodriguez M, Garcia-Reyes M, Martinez-Carnovale L, Marrero C, Gil M, Ruiz-Rodriguez JC, Ferrer R, de Nadal M, Monreal M, Llagostera S. COVID-19 Infection in Critically Ill Patients Carries a High Risk of Venous Thrombo-embolism. Eur J Vasc Endovasc Surg. 2021 Apr;61(4):628-634. doi: 10.1016/j.ejvs.2020.12.015. Epub 2020 Dec 23.

Reference Type: BACKGROUND

PMID: 33583710 (View on PubMed)

Wu C, Liu Y, Cai X, Zhang W, Li Y, Fu C. Prevalence of Venous Thromboembolism in Critically Ill Patients With Coronavirus Disease 2019: A Meta-Analysis. Front Med (Lausanne). 2021 Apr 29;8:603558. doi: 10.3389/fmed.2021.603558. eCollection 2021.

Reference Type: BACKGROUND

PMID: 33996843 (View on PubMed)

Marrero Eligio De La Puente CE, Flota Ruiz D, Besalduch LS, Capo XF, Sala DG, Ibars CP, Mindiolaza IB, Chiscano Camon LS, Sanmartin AR, Ruiz-Rodriguez JC, Ferrer R, Montoya SB. Systematic Ultrasound Screening for Lower Extremity Deep Vein Thrombosis in ICU Patients with Severe COVID-19: A Randomized Clinical Trial. J Intensive Care Med. 2025 Jul;40(7):739-748. doi: 10.1177/08850666251313774. Epub 2025 Jan 22.

Reference Type: DERIVED

PMID: 39838947 (View on PubMed)

Other Identifiers

P/R(AG)176/2021

Identifier Type: -

Identifier Source: org_study_id