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. 2021 Jul;52(1):69-75.
doi: 10.1007/s11239-020-02292-4. Epub 2020 Oct 6.

Occurrence of pulmonary embolism related to COVID-19

Marie Hauguel-Moreau  1   2   3   4 , Mostafa El Hajjam  5   6 , Quentin De Baynast  7 , Antoine Vieillard-Baron  8   9 , Anne-Sophie Lot  10 , Thierry Chinet  11   12 , Hazrije Mustafic  7   8 , Céline Bégué  7 , Robert Yves Carlier  5   6 , Guillaume Geri  8   9 , Olivier Dubourg  7   8 , Sébastien Beaune  13   14 , Nicolas Mansencal  7   8
Affiliations

Occurrence of pulmonary embolism related to COVID-19

Marie Hauguel-Moreau et al. J Thromb Thrombolysis. 2021 Jul.

Abstract

Recent reports have suggested an increased risk of pulmonary embolism (PE) related to COVID-19. The aim of this cohort study is to compare the incidence of PE during a 3-year period and to assess the characteristics of PE in COVID-19. We studied consecutive patients presenting with PE (January 2017-April 2020). Clinical presentation, computed tomography (CT) and biological markers were systematically assessed. We recorded the global number of hospitalizations during the COVID-19 pandemic and during the same period in 2018-2019. We included 347 patients: 326 without COVID-19 and 21 with COVID-19. Patients with COVID-19 experienced more likely dyspnea (p=0.04), had lower arterial oxygen saturation (p<0.001), higher C-reactive protein and white blood cell (WBC) count (p<0.0001 and p=0.001, respectively), and a significantly higher in-hospital mortality (14% versus 3.4%, p=0.04). Among COVID-19 patients, diagnosis of PE was performed at admission in 38% (n=8). COVID-19 patients with diagnosis of PE during hospitalization (n=13) had significantly more dyspnea (p=0.04), lower arterial oxygen saturation (p=0.01), less proximal PE (p=0.02), and higher heart rate (p=0.009), CT severity score (p=0.001), C-reactive protein (p=0.006) and WBC count (p=0.04). During the COVID-19 outbreak, a 97.4% increase of PE incidence was observed as compared to 2017-2019 and the proportion of hospitalizations related to PE was 3.7% versus 1.3% in 2018-2019 (p<0.0001). In conclusion, the COVID-19 pandemic leads to a dramatic increased incidence of PE. Physicians should be aware that PE may be diagnosed at admission, but also after several days of hospitalization, with a different clinical, CT and biological features of thrombotic disease.

Keywords: COVID-19; Pulmonary embolism; Thrombosis.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Pulmonary CT angiography with severe SARS-CoV-2 pneumonia showing a subsegmental pulmonary thrombus in the right posterior lower pulmonary artery (white arrows)
Fig. 2
Fig. 2
Number of patients presenting with pulmonary embolism from 2017 to 2020
See this image and copyright information in PMC

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