Pulmonary embolism in COVID-19 patients: a French multicentre cohort study

Fauvel, Charles; Weizman, Orianne; Trimaille, Antonin; Mika, Delphine; Pommier, Thibaut; Pace, Nathalie; Douair, Amine; Barbin, Eva; Fraix, Antoine; Bouchot, Océane; Benmansour, O.; Godeau, Guillaume; Mecheri, Yasmine; Lebourdon, Romane; Yvorel, Cédric; Massin, Michael; Leblon, Tiphaine; Chabbi, Chaima; Cugney, Erwan; Benabou, Léa; Aubry, M; Chan, Camille; Boufoula, Ines; Barnaud, Clement; Bothorel, Léa; Duceau, Baptiste; Sutter, Willy; Waldmann, Victor; Bonnet, Guillaume; Cohen, Ariel; Pezel, Théo

doi:10.1093/eurheartj/ehaa500

Cited by 233 publications

(281 citation statements)

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“…After excluding duplicates and preliminary screening, 151 full-text articles were assessed for eligibility and 130 studies were excluded for not meeting the inclusion criteria, leaving 23 investigation fulfilling the inclusion criteria ( Fig. 1) [1,3,4,8,12,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33].…”

Section: Search Results and Included Studiesmentioning

confidence: 99%

“…2, panel A). Higher rates were reported in ICU patients, ranging between 4.2 to 75.0% in the ten studies reviewed [1,3,4,8,[16][17][18][19][20]22,25,26,28]. In these patients, a pooled cumulative incidence rate of acute PE was 23.4% (95% CI:16.7-31.8%, I 2 =88.7%) ( Fig.…”

Section: Pooled In-hospital Incidence Of Acute Pulmonary Embolism Inmentioning

confidence: 88%

“…The cumulative in-hospital rate of acute PE in COVID-19 patients hospitalized in general wards ranged between 1.6 to 62.5% among six studies [1,8,17,20,21,23,24,[26][27][28][29][30][31][32][33]. A random effect model revealed a pooled incidence of acute PE in 14.7% of cases (95% CI: 9.9-21.3%, I 2 =95.0%) ( Fig.…”

Section: Pooled In-hospital Incidence Of Acute Pulmonary Embolism Inmentioning

confidence: 98%

“…Although the concomitant comorbidities were not systematically recorded by all investigations, active cancer and previous venous thromboembolic events were reported in a small percentage of cases. Fourteen studies considered ICU patients [1,3,4,8,[16][17][18][19][20]22,25,26,28] while fifteen provided data of subjects hospitalized in general wards [1,8,17,20,21,23,24,[26][27][28][29][30][31][32][33]. Seven studies reported the data of both ICU and general wards patients [1,8,17,19,20,26,28].…”

Section: Characteristics Of the Population And Quality Assessmentmentioning

confidence: 99%

“…However, very few investigations reported the number of PE patients treated before the diagnosis of acute PE, as shown in Table 2. The analysis of the prevalence of concomitant DVT [1,[21][22][23][24][25][26][27][28]30,33] ranged between 1.5% [8] to 33.3% [27].…”

Section: Imaging Techniques Adopted and Deep Vein Thrombosismentioning

confidence: 99%

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Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis.

Roncon

Zuin

Valerio

et al. 2020

European Journal of Internal Medicine

125

116

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Background: Acute pulmonary embolism (PE) has been described as a frequent and prognostically relevant complication of COVID-19 infection. Aim: We performed a systematic review and meta-analysis of the in-hospital incidence of acute PE among COVID-19 patients based on studies published within four months of COVID-19 outbreak. Material and Methods: Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in abstracting data and assessing validity. We searched Medline, Scopus and Web of Science to locate all articles published up to August 1, 2020 reporting the incidence of acute PE (or lung thrombosis) in COVID-19 patients. The pooled inhospital incidence of acute PE among COVID-19 patients was calculated using a random effects model and presenting the related 95% confidence interval (CI). Statistical heterogeneity was measured using the Higgins I 2 statistic. Results: We analysed data from 7178 COVID-19 patients [mean age 60.4 years] included in twenty-three studies. Among patients hospitalized in general wards and intensive care unit (ICU), the pooled in-hospital incidence of PE (or lung thrombosis) was 14.7% of cases (95% CI: 9.9-21.3%, I 2 =95.0%, p<0.0001) and 23.4% (95% CI:16.7-31.8%, I2=88.7%, p<0.0001), respectively. Segmental/sub-segmental pulmonary arteries were more frequently involved compared to main/lobar arteries (6.8% vs18.8%, p<0.001). Computer tomography pulmonary angiogram (CTPA) was used only in 35.3% of patients with COVID-19 infection across six studies. Conclusions: The in-hospital incidence of acute PE among COVID-19 patients is higher in ICU patients compared to those hospitalized in general wards. CTPA was rarely used suggesting a potential underestimation of PE cases.

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Section: Search Results and Included Studiesmentioning

confidence: 99%

Section: Pooled In-hospital Incidence Of Acute Pulmonary Embolism Inmentioning

confidence: 88%

Section: Pooled In-hospital Incidence Of Acute Pulmonary Embolism Inmentioning

confidence: 98%

Section: Characteristics Of the Population And Quality Assessmentmentioning

confidence: 99%

Section: Imaging Techniques Adopted and Deep Vein Thrombosismentioning

confidence: 99%

See 3 more Smart Citations

Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis.

Roncon

Zuin

Valerio

et al. 2020

European Journal of Internal Medicine

125

116

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Effects of Standard-Dose Prophylactic, High-Dose Prophylactic, and Therapeutic Anticoagulation in Patients With Hypoxemic COVID-19 Pneumonia

et al. 2023

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ImportanceGiven the high risk of thrombosis and anticoagulation-related bleeding in patients with hypoxemic COVID-19 pneumonia, identifying the lowest effective dose of anticoagulation therapy for these patients is imperative.ObjectivesTo determine whether therapeutic anticoagulation (TA) or high-dose prophylactic anticoagulation (HD-PA) decreases mortality and/or disease duration compared with standard-dose prophylactic anticoagulation (SD-PA), and whether TA outperforms HD-PA; and to compare the net clinical outcomes among the 3 strategies.Design, Settings, and ParticipantsThe ANTICOVID randomized clinical open-label trial included patients with hypoxemic COVID-19 pneumonia requiring supplemental oxygen and having no initial thrombosis on chest computer tomography with pulmonary angiogram at 23 health centers in France from April 14 to December 13, 2021. Of 339 patients randomized, 334 were included in the primary analysis—114 patients in the SD-PA group, 110 in the HD-PA, and 110 in the TA. At randomization, 90% of the patients were in the intensive care unit. Data analyses were performed from April 13, 2022, to January 3, 2023.InterventionsPatients were randomly assigned (1:1:1) to receive either SD-PA, HD-PA, or TA with low-molecular-weight or unfractionated heparin for 14 days.Main Outcomes and MeasuresA hierarchical criterion of all-cause mortality followed by time to clinical improvement at day 28. Main secondary outcome was net clinical outcome at day 28 (composite of thrombosis, major bleeding, and all-cause death).ResultsAmong the study population of 334 individuals (mean [SD] age, 58.3 [13.0] years; 226 [67.7%] men and 108 [32.3%] women), use of HD-PA and SD-PA had similar probabilities of favorable outcome (47.3% [95% CI, 39.9% to 54.8%] vs 52.7% [95% CI, 45.2% to 60.1%]; P = .48), as did TA compared with SD-PA (50.9% [95% CI, 43.4% to 58.3%] vs 49.1% [95% CI, 41.7% to 56.6%]; P = .82) and TA compared with HD-PA (53.5% [95% CI 45.8% to 60.9%] vs 46.5% [95% CI, 39.1% to 54.2%]; P = .37). Net clinical outcome was met in 29.8% of patients receiving SD-PA (20.2% thrombosis, 2.6% bleeding, 14.0% death), 16.4% receiving HD-PA (5.5% thrombosis, 3.6% bleeding, 11.8% death), and 20.0% receiving TA (5.5% thrombosis, 3.6% bleeding, 12.7% death). Moreover, HD-PA and TA use significantly reduced thrombosis compared with SD-PA (absolute difference, −14.7 [95% CI −6.2 to −23.2] and −14.7 [95% CI −6.2 to −23.2], respectively). Use of HD-PA significantly reduced net clinical outcome compared with SD-PA (absolute difference, −13.5; 95% CI −2.6 to −24.3).Conclusions and RelevanceThis randomized clinical trial found that compared with SD-PA, neither HD-PA nor TA use improved the primary hierarchical outcome of all-cause mortality or time to clinical improvement in patients with hypoxemic COVID-19 pneumonia; however, HD-PA resulted in significantly better net clinical outcome by decreasing the risk of de novo thrombosis.Trial RegistrationClinicalTrials.gov Identifier: NCT04808882

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COVID-19 and its cardiovascular effects: a systematic review of prevalence studies

Pellicori

Doolub

Wong

et al. 2021

Cochrane Database of Systematic Reviews

102

121

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BackgroundA small minority of people with coronavirus disease 2019 (COVID-19) develop a severe illness, characterised by inflammation, microvascular damage and coagulopathy, potentially leading to myocardial injury, venous thromboembolism (VTE) and arterial occlusive events. People with risk factors for or pre-existing cardiovascular disease may be at greater risk. ObjectivesTo assess the prevalence of pre-existing cardiovascular comorbidities associated with suspected or confirmed cases of COVID-19 in a variety of settings, including the community, care homes and hospitals. We also assessed the nature and rate of subsequent cardiovascular complications and clinical events in people with suspected or confirmed COVID-19. Search methodsWe conducted an electronic search from December 2019 to 24 July 2020 in the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, covid-19.cochrane.org, ClinicalTrials.gov and EU Clinical Trial Register. Selection criteriaWe included prospective and retrospective cohort studies, controlled before-and-a er, case-control and cross-sectional studies, and randomised controlled trials (RCTs). We analysed controlled trials as cohorts, disregarding treatment allocation. We only included peerreviewed studies with 100 or more participants, and excluded articles not written in English or only published in pre-print servers.COVID-19 and its cardiovascular e ects: a systematic review of prevalence studies (Review)

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Pulmonary embolism in COVID-19 patients: a French multicentre cohort study

Cited by 233 publications

References 25 publications

Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis.

Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis.

Effects of Standard-Dose Prophylactic, High-Dose Prophylactic, and Therapeutic Anticoagulation in Patients With Hypoxemic COVID-19 Pneumonia

COVID-19 and its cardiovascular effects: a systematic review of prevalence studies

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