Late-onset of pulmonary embolism following hospitalization for COVID-19 despite thromboprophylaxis: a report of two cases

Abstract

The global pandemic caused by the SARS-CoV-2 has resulted in an increased incidence of venous thromboembolism among hospitalized COVID-19-patients, especially those who required intensive care, despite thromboprophylaxis. This has resulted in the use of higher doses of thromboprophylaxis or therapeutic anticoagulation therapy even in the absence of thrombotic events. However, after their hospital discharge, authors and current guidelines are not unanimous about extended anticoagulant therapy in patients with COVID-19. Here, we report two pulmonary embolism cases following hospitalization for COVID-19, despite intermediate doses of thromboprophylaxis. These rare cases suggest that there may be a residual thrombotic risk following hospitalization for COVID-19 and highlight questions about extended prophylactic-anticoagulation therapy after hospital discharge of patients with COVID-19.

Acute Pulmonary Embolism Post COVID-19 Pneumonia – A Case Report

“…However the development of the thromboembolism raises many questions about the incidence, risk factors for developing the complication and the prevention and management strategies for the same. Similar cases have been reported elsewhere [10][11][12]. In a large study that involved over 3000 individuals admitted to the hospital, most of whom received prophylactic-dose anticoagulation, risk factors for Venous Thrombo-embolism (VTE) on multivariate analysis were older age, male sex, Hispanic ethnicity, coronary artery disease, prior myocardial infarction, and higher D-dimer (>500 ng/mL) at hospital presentation [1].…”

“…While, thromboembolic complications have been found in patients with COVID-19 [10,12], there still exists no safely proven effective preventive therapy for the same. Clinical trials to establish must be carried out to find the same.…”

Pulmonary Thrombosis despite Therapeutic Anticoagulation in COVID-19 Pneumonia: A Case Report and Literature Review

“…Within the available data, in the majority of cases, a peripheral segmental/subsegmental thrombosis was recorded, but some patients also had an involvement of the main/lobar pulmonary arteries [ 40 , 42 , 45 ]. High-risk PT was described in only a few patients from different papers [ 25 , 28 , 37 , 39 , 40 , 44 , 45 , 46 ]. The localisation of PT, as a predominant segmental/subsegmental lung microthrombosis, is associated with widespread parenchymal abnormalities [ 25 , 29 ].…”

“…Pulmonary thrombotic risk factors in patients with COVID-19 are rather inflammation-related (including severe/critical COVID-19) than traditional thromboembolic risk factors [ 37 , 38 , 39 , 40 , 43 , 44 , 45 ].…”

Pulmonary Embolism in Post-CoviD-19 Patients, a Literature Review: Red Flag for Increased Awareness?

“…Namely, 32 cases didn't need hospitalization or were asymptomatic during COVID-19 infection. Two patients were under Low Molecular Weight Heparin (LMWH) [33] and one under oral anticoagulants [41]. The cases concern almost equally patients in the 4th, 5th, and 6th decade of life.…”