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. 2020 Nov:195:95-99.
doi: 10.1016/j.thromres.2020.07.025. Epub 2020 Jul 10.

Pulmonary embolism in hospitalised patients with COVID-19

Martin B Whyte  1 , Philip A Kelly  2 , Elisa Gonzalez  2 , Roopen Arya  3 , Lara N Roberts  4
Affiliations

Pulmonary embolism in hospitalised patients with COVID-19

Martin B Whyte et al. Thromb Res. 2020 Nov.

Abstract

Background: Coronavirus disease 2019 (COVID-19) is characterised by dyspnoea and abnormal coagulation parameters, including raised D-dimer. Data suggests a high incidence of pulmonary embolism (PE) in ventilated patients with COVID-19.

Objectives: To determine the incidence of PE in hospitalised patients with COVID-19 and the diagnostic yield of Computer Tomography Pulmonary Angiography (CTPA) for PE. We also examined the utility of D-dimer and conventional pre-test probability for diagnosis of PE in COVID-19.

Patients/methods: Retrospective review of single-centre data of all CTPA studies in patients with suspected or confirmed COVID-19 identified from Electronic Patient Records (EPR).

Results: There were 1477 patients admitted with COVID-19 and 214 CTPA scans performed, of which n = 180 (84%) were requested outside of critical care. The diagnostic yield for PE was 37%. The overall proportion of PE in patients with COVID-19 was 5.4%. The proportions with Wells score of ≥4 ('PE likely') was 33/134 (25%) without PE vs 20/80 (25%) with PE (P = 0.951). The median National Early Warning-2 (NEWS2) score (illness severity) was 5 (interquartile range [IQR] 3-9) in PE group vs 4 (IQR 2-7) in those without PE (P = 0.133). D-dimer was higher in PE (median 8000 ng/mL; IQR 4665-8000 ng/mL) than non-PE (2060 ng/mL, IQR 1210-4410 ng/mL, P < 0.001). In the 'low probability' group, D-dimer was higher (P < 0.001) in those with PE but had a limited role in excluding PE.

Conclusions: Even outside of the critical care environment, PE in hospitalised patients with COVID-19 is common. Of note, approaching half of PE events were diagnosed on hospital admission. More data are needed to identify an optimal diagnostic pathway in patients with COVID-19. Randomised controlled trials of intensified thromboprophylaxis are urgently needed.

Keywords: COVID-19; Coronavirus; D-dimer; Pulmonary embolism.

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Conflict of interest statement

The authors have no disclosures.

Figures

Fig. 1
Fig. 1
Study flow-chart.
Fig. 2
Fig. 2
Distribution of D-dimer values in patients at low- and high-probability for Pulmonary Embolism. Low probability considered as Wells score of <4.
Fig. 3
Fig. 3
Receiver Operating Characteristic (ROC) curve for D-dimer for the diagnosis of Pulmonary Embolism.
See this image and copyright information in PMC

Comment in

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