Pulmonary embolism in coronavirus disease 2019: the silent killer

Abstract

Background Pulmonary embolism (PE) has been identified as one of the deadliest complications of coronavirus disease 2019 (COVID-19), especially in patients admitted to the intensive care unit (ICU). Western literature reminds us of the high prevalence of PE in COVID. Here, we report a series of 13 cases of PE diagnosed and managed at our hospital. Methods Retrospective analysis of medical records of 13 cases of PE admitted at our hospital from February 1, 2020, to September 31, 2020, were done. Their clinical, laboratory, and radiologic data were assessed in detail. Results Computed tomography pulmonary arteriography was used to make the diagnosis in eight patients (61.53%), and clinical findings with corroborative ultrasound and laboratory parameters were used to label PE in five patients (38.46%). Five patients were hemodynamically unstable, requiring thrombolysis with recombinant tissue plasminogen activator, and four patients (30.76%) suffered a fatal outcome. Conclusion COVID-19 is a highly prothrombotic state, and all physicians should keep a high vigilance for PE. All hospitalized patients with COVID-19, especially those admitted in ICU, should be on prophylactic anticoagulation and, if there is any worsening, should be started on therapeutic regimen. Patients at the time of discharge should be switched to oral anticoagulation, which should be continued for at least 3–6 months.

Pulmonary Thromboembolism on CT Pulmonary Angiography of Covid-19 Patients and Its Correlation to CT Severity Score, D-dimer, and Ferritin Levels: A Prospective and Retrospective Study

“…The study also reports that COVID-19 patients who were admitted to hospitals and did not survive showed higher serum ferritin levels. Marwah et al's [23] retrospective analysis and Carubbi et al's [24] prospective study points out that serum ferritin has been suitably characterized as a severe phase reactant and a linkage of immune dysregulation in severe COVID-19.…”

“…Galland et al state that the prevalence of thrombotic events is related to the combination of hypoxia with an immune-triggered thrombo-inflammation is a cause coagulability and endothelial injuries [32]. Since hyperferritinemia is linked to inflammatory states in severe acute respiratory COVID-19 infection, ferritin might probably be a convenient aspect to predict the severity of the disease and the level of the cytokine storm [23].…”

“…Marwah et al [23] and Carubbi et al [24] state that serum ferritin is suitably characterized as a severe phase reactant and a linkage of immune dysregulation in severe COVID-19 infection. Composite feedback approaches between cytokines and serum ferritin in controlling anti-inflammatory and pro-inflammatory mediators can be termed cytokines-inducing ferritin expression.…”