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2020 ; 195
(ä): 95-99
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Pulmonary embolism in hospitalised patients with COVID-19
#MMPMID32682004
Whyte MB
; Kelly PA
; Gonzalez E
; Arya R
; Roberts LN
Thromb Res
2020[Nov]; 195
(ä): 95-99
PMID32682004
show ga
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.
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