Characteristics of Acute Pulmonary Embolism in Patients With COVID-19 Associated Pneumonia From the City of Wuhan

Abstract

The aim of this study was to describe clinical, imaging, and laboratory features of acute pulmonary embolism (APE) in patients with COVID-19 associated pneumonia. Patients with COVID-19 associated pneumonia who underwent a computed tomography pulmonary artery (CTPA) scan for suspected APE were retrospectively studied. Laboratory data and CTPA images were collected. Imaging characteristics were analyzed descriptively. Laboratory data were analyzed and compared between patients with and without APE. A series of 25 COVID-19 patients who underwent CTPA between January 2020 and February 2020 were enrolled. The median D-dimer level founded in these 25 patients was 6.06 μg/mL (interquartile range [IQR] 1.90-14.31 μg/mL). Ten (40%) patients with APE had a significantly higher level of D-dimer (median, 11.07 μg/mL; IQR, 7.12-21.66 vs median, 2.44 μg/mL; IQR, 1.68-8.34, respectively, P = .003), compared with the 15 (60%) patients without APE. No significant differences in other laboratory data were found between patients with and without APE. Among the 10 patients with APE, 6 (60%) had a bilateral pulmonary embolism, while 4 had a unilateral embolism. The thrombus-prone sites were the right lower lobe (70%), the left upper lobe (60%), both upper lobe (40%) and the right middle lobe (20%). The thrombus was partially or completely absorbed after anticoagulant therapy in 3 patients who underwent a follow-up CTPA. Patients with COVID-19 associated pneumonia have a risk of developing APE during the disease. When the D-dimer level abnormally increases in patients with COVID-19 pneumonia, CTPA should be performed to detect and assess the severity of APE.

A higher D-dimer threshold for predicting pulmonary embolism in patients with COVID-19: a retrospective study

“…The incidence of PE was 30% (73/242), similar to that reported by other recent studies [10,12,[28][29][30]. Three recent studies showed disparity results [31][32][33]. Of note, only 5/73 patients with PE had a confirmed diagnosis of deep vein thrombosis (DVT).…”

“…In our sample, 96% (205/ 242) of the patients showed a DD value above normal limits (median 3260 ng/mL, [IQR 1203-9625]). Despite elevated DD levels in most patients, the PE-positive group showed higher values than the PE-negative group (7872 vs. 2009 ng/ mL, respectively, p < .001), similarly to other studies [28,[30][31][32][33]. Thus, DD along with other clinical and laboratory data can be used as a tool to effectively assess pre-CTPA PE risk in COVID-19 patients.…”

COVID-19 associated thrombotic thrombocytopenic purpura (TTP) ; A case series and mini-review

“…There are several manifestations of COVID-19 coagulopathy, such as deep venous thrombosis, pulmonary thromboembolism, and thrombotic microangiopathies. Out of 1008 patients with COVID-19, who underwent pulmonary CT-Angiography, Up to 40% of patients had small branches pulmonary thromboembolism [9] .…”

Immune Mechanisms in Cardiovascular Diseases Associated With Viral Infection

“…Coagulopathy is one of the most concerning sequelae in COVID-19 patients. Several reports have shown mortality associated with pulmonary emboli and venous thrombosis in severely ill COVID-19 patients (192)(193)(194)(195)(196)(197)(198)(199). Interestingly, a study by Wichmann et al described the results of 12 mandatory autopsies of COVID-19, PCR confirmed patients.…”