[Acute pulmonary embolism in times of SARS-CoV-2: Diagnostic and therapeutic management]

Abstract

There is a clear association between novel coronavirus 2 infection and the diagnosis of venous thromboembolic disease, as a cosequence of the development of a systemic inflammatory response syndrome due to the activation of the coagulation cascade. It occurs in 90% of patients with severe forms of the infection, evidencing the presence of pulmonary endovascular micro and macro thrombosis. This suggests a possible clinical benefit of thromboprophylaxis according to the patient’s clinical risk. The suspicion of venous thromboembolic disease in the context of this pandemic represents a diagnostic challenge due to the co-existence of similarities between both conditions in several different aspects. It should be noted that the diagnosis of acute pulmonary embolism does not exclude the possibility of simultaneous viral infection. The evaluation of patients with suspected acute pulmonary embolism in the context of the pandemic should be optimized in order to implement a rapid diagnosis and treatment to reduce the associated morbidity and mortality. This will help reducing infectious risk for health-care professionals and other patients.

Keywords: Embolia pulmonar; Infecciones por coronavirus; COVID-19; Trombosis.

Figura 1

Algoritmo terapéutico en pacientes con inestabilidad hemodinámica.

Figura 2

Algoritmo terapéutico en pacientes con estabilidad hemodinámica. ^aResidencia en zonas con circulación comunitaria, historial de viaje a éstas o contacto con casos confirmados en los últimos 14 días. La definición de caso sospechoso puede variar en cada país, por lo que cada centro debe regirse por las recomendaciones locales. ^bSegún juicio clínico o escalas validadas antes de la prueba (Wells o Ginebra). ^cSi el DD del hospital es de moderada sensibilidad, debe restringirse este paso a pacientes sólo de baja probabilidad. ^dValorar alteraciones del parénquima pulmonar indicativas de COVID-19. ^eValorar alteraciones del parénquima pulmonar indicativas de COVID-19 para determinar casos sospechosos oligosintomáticos. ^fEn caso de angiotomografía pulmonar negativa en pacientes con alta probabilidad clínica, considerar pruebas de imagen adicionales.