Prevalence of pulmonary embolism and deep venous thrombosis during the COVID-19 pandemic in an intensive care unit cohort: a service evaluation

Barnett, Nick; Leith, Donald; Govind, Darshna; Ramnani, Ved; Williamson, Hannah M; Chung, Jameson; Drebes, Anja

doi:10.1016/j.bja.2022.07.040

Cited by 3 publications

(7 citation statements)

References 11 publications

(13 reference statements)

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“…Diffuse, segmental/subsegmental thrombosis is predominant in COVID-19 patients [ 33 , 34 , 144 , 145 , 146 , 147 ]. As small peripheral lung thrombi are more prevalent in COVID-19, evaluating the subsegmental pulmonary arteries by computed tomography pulmonary angiogram is essential [ 33 , 148 , 149 ]. In their study, Cau et al found that in 87% of cases, pulmonary thrombosis was in lung parenchyma affected by COVID-19 pneumonia [ 150 ].…”

Section: Chest Ct Imaging Data Supporting the Role Of Pulmonary Immun...mentioning

confidence: 99%

“…Pulmonary thrombosis cases occurred in the absence of a recognizable DVT; in two-thirds of cases, most of them involving the distal vessels [ 159 ]. Peripheral pulmonary blood clots, predominant in COVID-19 as showed earlier, reflect in situ thrombosis rather than DVT embolism, which is associated with a more centrally located clot burden [ 149 , 160 ]. The presence of DVT at a distal level (below knee) could be an indicator for in situ thrombosis (COVID-19 thrombotic phenotype) and at a proximal level (above knee), especially if there are associate pulmonary central clots (in a main/lobar artery), could suggest an embolic origin [ 149 ].…”

Section: The Role Of Venous Thromboembolismmentioning

confidence: 99%

“…Peripheral pulmonary blood clots, predominant in COVID-19 as showed earlier, reflect in situ thrombosis rather than DVT embolism, which is associated with a more centrally located clot burden [ 149 , 160 ]. The presence of DVT at a distal level (below knee) could be an indicator for in situ thrombosis (COVID-19 thrombotic phenotype) and at a proximal level (above knee), especially if there are associate pulmonary central clots (in a main/lobar artery), could suggest an embolic origin [ 149 ]. Central pulmonary emboli are also related to lung cancer, and these patients usually have other associated risk factors for venous thromboembolic disease and worse outcomes [ 161 ].…”

Section: The Role Of Venous Thromboembolismmentioning

confidence: 99%

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Mechanisms of COVID-19 Associated Pulmonary Thrombosis: A Narrative Review

2023

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COVID-19, the infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is frequently associated with pulmonary thrombotic events, especially in hospitalized patients. Severe SARS-CoV-2 infection is characterized by a proinflammatory state and an associated disbalance in hemostasis. Immune pathology analysis supports the inflammatory nature of pulmonary arterial thrombi composed of white blood cells, especially neutrophils, CD3+ and CD20+ lymphocytes, fibrin, red blood cells, and platelets. Immune cells, cytokines, chemokines, and the complement system are key drivers of immunothrombosis, as they induce the damage of endothelial cells and initiate proinflammatory and procoagulant positive feedback loops. Neutrophil extracellular traps induced by COVID-19-associated “cytokine storm”, platelets, red blood cells, and coagulation pathways close the inflammation–endotheliopathy–thrombosis axis, contributing to SARS-CoV-2-associated pulmonary thrombotic events. The hypothesis of immunothrombosis is also supported by the minor role of venous thromboembolism with chest CT imaging data showing peripheral blood clots associated with inflammatory lesions and the high incidence of thrombotic events despite routine thromboprophylaxis. Understanding the complex mechanisms behind COVID-19-induced pulmonary thrombosis will lead to future combination therapies for hospitalized patients with severe disease that would target the crossroads of inflammatory and coagulation pathways.

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Section: Chest Ct Imaging Data Supporting the Role Of Pulmonary Immun...mentioning

confidence: 99%

Section: The Role Of Venous Thromboembolismmentioning

confidence: 99%

Section: The Role Of Venous Thromboembolismmentioning

confidence: 99%

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Mechanisms of COVID-19 Associated Pulmonary Thrombosis: A Narrative Review

2023

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Section: Introductionmentioning

confidence: 99%

“…[3,8] As segmental and/or subsegmental thrombi are more prevalent, evaluating the peripheral pulmonary arteries by a computed tomography (CT) pulmonary angiogram is essential in order to optimize the overall management of COVID-19 patients. [9][10][11][12][13][14][15][16] Moreover, chest imaging data of patients with SARS-CoV-2 infection could be used to analyze the association between lung inflammatory lesions and in situ vascular thrombosis. [8,14,[17][18][19] In this study we aimed to describe clinical, quantitative chest CT imaging characteristics based on density ranges (Hounsfield units) and outcome of patients with COVID-19 associated pulmonary artery thrombosis.…”

Section: Introductionmentioning

confidence: 99%

Quantitative chest CT imaging characteristics and outcome of patients with COVID-19 associated pulmonary artery thrombosis: A single-center retrospective cohort study

et al. 2023

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Coronavirus disease 2019 (COVID-19)-associated pulmonary thrombotic events occur frequently and are associated with disease severity and worse clinical outcomes. We aimed to describe the clinical and quantitative chest computed tomography (CT) imaging characteristics based on density ranges (Hounsfield units) and the outcomes of patients with COVID-19 associated pulmonary artery thrombosis. This retrospective cohort study included all patients with COVID-19 hospitalized in a tertiary care hospital between March 2020 and June 2022 who underwent a CT pulmonary angiography. We included 73 patients: 36 (49.3%) with and 37 (50.7%) without pulmonary artery thrombosis. The in-hospital all-cause mortality was 22.2 versus 18.9% (P = .7), and the intensive care unit admission rates were 30.5 versus 8.1% (P = .01) at the time of diagnosis of pulmonary artery thrombosis. Except for D-dimers (median of 3142 vs 533, P = .002), the other clinical, coagulopathy, and inflammatory markers were similar. Logistic regression analysis revealed that only D-dimers were associated with pulmonary artery thrombosis (P = .012). ROC curve analysis of D-dimers showed that a value greater than 1716 ng/mL predicted pulmonary artery thrombosis with an area under the curve of 0.779, 72.2% sensitivity, and 73% specificity (95% CI 0.672–0.885). Peripheral distribution of pulmonary artery thrombosis was recorded in 94.5% of cases. In the lower lobes of the lungs, the incidence of pulmonary artery thrombosis was 6 times higher than that in the upper lobes (58–64%), with a percentage of lung injury of 80% to 90%. Analysis of the distribution of arterial branches with filling defects revealed that 91.6% occurred in lung areas with inflammatory lesions. Quantitative chest CT imaging provides valuable information regarding the extent of COVID-19 associated lung damage and can be used to anticipate the co-location of pulmonary immunothrombotic events. In patients with severe COVID-19, in-hospital all-cause mortality was similar regardless of the presence of associated distal pulmonary thrombosis.

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The impact of gender differences on the clinical characteristics of critically ill patients with venous thromboembolism: A retrospective, observational study

He,

Ye,

Zheng

et al. 2024

Medicine

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The aim of this study is to describe the general information, disease and treatment of venous thromboembolism (VTE) in critically ill patients, to explore the characteristics of severe patients with deep venous VTE and provide clinical reference data for the prevention and treatment of VTE in critically ill patients. This study carried out a retrospective study on the medical records of patients who were treated in the intensive care unit of Affiliated Hospital of Jining Medical College from 2020 to 2022. The general data, general conditions, drug use, past history, VTE prevention measures, post-VTE conditions, and Padua risk score of 297 patients with VTE during the period of hospitalization in intensive care unit (ICU) were classified and statistically analyzed. A total of 297 including 171 male and 126 male patient medical records were included in the analysis, we compared multiple clinical indicators between male and female patients. Compared to women, male patients have a higher acute physiology and chronic health evaluation II score(APACHE-II score) (P = .027), a higher state of consciousness (P = .003), a higher rate of smoking and drinking history (P < .001), a lower rate of heart failure (P = .003) and chronic depression (P = .013), and a higher rate of recommended operations for male patients after VTE (P = .031). The prothrombin time (PT) (P = .041) and activated partial thromboplastin time (APTT) (P = .040) of male patients were significantly higher than those of female patients, while triglyceride (P = .009) and total cholesterol (TC) (P = .001) were significantly lower than those of female patients. The difference in D-dimer (P = .739) was not significant. This study shows that male and female patients with VTE in the ICU have significant differences in general characteristics, general clinical conditions, history of past illness, thrombosis character, and examination items, this may be the reason for the different rates of VTE between male and female patients in the ICU.

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Prevalence of pulmonary embolism and deep venous thrombosis during the COVID-19 pandemic in an intensive care unit cohort: a service evaluation

Cited by 3 publications

References 11 publications

Mechanisms of COVID-19 Associated Pulmonary Thrombosis: A Narrative Review

Mechanisms of COVID-19 Associated Pulmonary Thrombosis: A Narrative Review

Quantitative chest CT imaging characteristics and outcome of patients with COVID-19 associated pulmonary artery thrombosis: A single-center retrospective cohort study

The impact of gender differences on the clinical characteristics of critically ill patients with venous thromboembolism: A retrospective, observational study

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