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Pulmonary embolism in hospitalised patients with COVID-19.
- Source :
-
Thrombosis research [Thromb Res] 2020 Nov; Vol. 195, pp. 95-99. Date of Electronic Publication: 2020 Jul 10. - Publication Year :
- 2020
-
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.<br />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.<br />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).<br />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.<br />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.<br /> (Copyright © 2020 Elsevier Ltd. All rights reserved.)
- Subjects :
- Betacoronavirus isolation & purification
Blood Coagulation
COVID-19
Computed Tomography Angiography
Coronavirus Infections blood
Female
Fibrin Fibrinogen Degradation Products analysis
Hospitalization
Humans
Incidence
Male
Middle Aged
Pandemics
Pneumonia, Viral blood
Pulmonary Embolism blood
Pulmonary Embolism diagnostic imaging
Retrospective Studies
SARS-CoV-2
Coronavirus Infections complications
Pneumonia, Viral complications
Pulmonary Embolism etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1879-2472
- Volume :
- 195
- Database :
- MEDLINE
- Journal :
- Thrombosis research
- Publication Type :
- Academic Journal
- Accession number :
- 32682004
- Full Text :
- https://doi.org/10.1016/j.thromres.2020.07.025