Massive pulmonary embolism following recovery from COVID-19 infection: inflammation, thrombosis and the role of extended thromboprophylaxis

Vadukul, Prakash; Sharma, Deepak; Vincent, Paul K.

doi:10.1136/bcr-2020-238168

Cited by 27 publications

(38 citation statements)

References 29 publications

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“…It is more common in the intensive care unit with some extent found during the recovery period that can happen even after discharge from hospital. 2 Although recent studies recommend antithrombotic therapy with heparin in COVID-19 critically ill patients, the risk–benefit ratio is still unknown, and several randomised controlled trials such as HEP-COVID, IMPROVE-COVID and INHIXACOVID19 are still undertaken to study the efficacy and safety of heparin therapy in patients with severe COVID-19 pneumonia. Recently, there are rising numbers of papers reporting major internal bleeding such as retroperitoneal haemorrhage as a complication of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Double-edged sword effect of anticoagulant in COVID-19 infection

Ohn

et al. 2021

BMJ Case Rep

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Coagulation predominant-type coagulopathy such as microthrombosis and macrothrombosis is a well-known recognised complication found in COVID-19 infected critically ill patients. In the context of high incidence of thrombotic events in patients with COVID-19, supplementation with anticoagulant therapy has been routinely recommended and shown to reduce mortality. However, the recommended type, dose, duration and timing of anticoagulant has not been determined yet. Spontaneous retroperitoneal haematoma secondary to anticoagulant therapy is one of the well-known but self-limiting conditions. We report a 51-year-old COVID-19 positive woman, who was taking intermediate-intensity heparin therapy for venous thromboembolism prophylaxis and died from complication of retroperitoneal bleeding. Further studies are needed to verify the risk–benefit ratio of anticoagulant therapy in patients with COVID-19. Although anticoagulant deems appropriate to use in patients with COVID-19, clinicians should be cautious about major bleeding complication such as retroperitoneal haemorrhage even when full therapeutic dosage is not used.

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Section: Discussionmentioning

confidence: 99%

Double-edged sword effect of anticoagulant in COVID-19 infection

Ohn

et al. 2021

BMJ Case Rep

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“…Indeed, PE is the most frequent thromboembolic complication during the COVID-19 disease, especially in critically ill patients [ 5 ]. Furthermore, this hypercoagulable state seems to persist even after the hospital discharge of patients with COVID-19, despite well-conducted thromboprophylaxis [ 7 ]. However, these events are not known to occur in asymptomatic COVID-19 patients or in those recovered from active SARS-CoV-2 infection.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the incidence of PE among ambulatory COVID-19 patients is not yet clearly defined. There have been a few reports of pulmonary thromboembolic events in recovered patients with COVID-19 [ 7 - 9 ].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Pulmonary Embolism in Patients Recovered From Asymptomatic COVID-19 Infection

Brem¹,

Rasras²,

Ouafi³

et al. 2021

Cureus

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Hypercoagulability state is common in patients with coronavirus disease 2019 (COVID-19), especially those requiring intensive care. Indeed, anticoagulation therapy is recommended for all hospitalized COVID-19-patients. Despite well-conducted thromboprophylaxis, so many patients have developed these life-threatening complications. However, these thrombotic events are not known to occur in asymptomatic COVID-19 patients or in those recovered from active severe acute respiratory syndrome coronavirus 2 infection. This case series of a bilateral pulmonary embolism that occurred in patients recovered from asymptomatic COVID-19 highlights the questions about extending thromboprophylaxis in ambulatory patients with COVID-19.

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“…Hospitalized patients, when getting discharged and apparently seeming stable and asymptomatic, may still have the procoagulant effect of COVID-19 extended by a few weeks. This, combined with less mobility during hospitalization and other complications, puts the patient at a high suspicion of recurrent PE after discharge [ 127 , 128 ]. It is evident from retrospective observational cohort studies that COVID-19 patients discharged from the hospital without anticoagulation had a cumulative incidence of thrombosis (2.5%), VTE (0.6%), and major hemorrhage (0.7%) with clinically relevant non-major bleeds (2.9%) on day 30 following discharge [ 129 ].…”

Section: Post-covid-19 Thromboprophylaxismentioning

confidence: 99%

SARS-CoV-2 Infection: Modulator of Pulmonary Embolism Paradigm

Akhter

Hamali

Mobarki

et al. 2021

JCM

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Pulmonary embolism (PE) is a life-threatening complication arising from venous thromboembolism with a difficult diagnosis and treatment and is often associated with increased mortality and morbidity. PE had a significantly low incidence prior to the COVID-19 epidemic. This condition saw a sharp surge during the COVID-19 pandemic, indicating an evident viral influence on PE’s pathophysiology in COVID-19 patients. The hypercoagulable state induced by the viral load seems to be the major contributor, and the classical causative factors seem to play a lesser role. PE in COVID-19 infection has become a mammoth challenge since the diagnosis is quite challenging due to overlapping symptoms, lack of prior-known predisposing risk factors, limited resources, and viral transmittance risk. Numerous factors arising out of the viral load or treatment lead to an increased risk for PE in COVID-19 patients, besides the fact that certain unknown risk factors may also contribute to the incidence of PE in COVID-19 patients. The management of PE in COVID-19 infection mainly comprises thromboprophylaxis and anticoagulant therapy with mechanical ventilation, depending on the risk stratification of the patient, with a post-COVID-19 management that prevents recurrent PE and complications. This review aims to discuss various aspects of COVID-19-infection-associated PE and major differential aspects from non-COVID-19 PE.

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Massive pulmonary embolism following recovery from COVID-19 infection: inflammation, thrombosis and the role of extended thromboprophylaxis

Cited by 27 publications

References 29 publications

Double-edged sword effect of anticoagulant in COVID-19 infection

Double-edged sword effect of anticoagulant in COVID-19 infection

Bilateral Pulmonary Embolism in Patients Recovered From Asymptomatic COVID-19 Infection

SARS-CoV-2 Infection: Modulator of Pulmonary Embolism Paradigm

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