Pulmonary embolism in patients with severe COVID-19 treated with intermediate- to full-dose enoxaparin: A retrospective study

Scarduelli, Cleante; Beccaria, Massimiliano; Speafico, Fabio; Garuti, Martina; Pecoriello, Antonietta; Cervi, Giulia; Greco, Graziana Francesca; Sulzbach, Sara; Lucchini, Giuseppe; Donno, Giuseppe De; Borghi, Claudio

doi:10.4081/monaldi.2021.1758

Cited by 7 publications

(13 citation statements)

References 21 publications

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“…On pooled analysis, patients with acute pulmonary embolism showed a significantly higher mortality risk in the short-term period (OR: 1.76, 95% CI: 1.26–2.47, P = 0.001, I 2 = 0%) (Fig. 1, panel a) 11–18 . The visual inspection of the relative funnel plot did not reveal significant evidence of publication bias (Fig.…”

Section: Resultsmentioning

confidence: 93%

COVID-19 patients with acute pulmonary embolism have a higher mortality risk: systematic review and meta-analysis based on Italian cohorts

Zuin

Rigatelli

Bilato

et al. 2022

Journal of Cardiovascular Medicine

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Background Acute pulmonary embolism has been recognized as a frequent complication of COVID-19 infection influencing the clinical course and outcomes of these patients.Objectives We performed a systematic review and metaanalysis to evaluate the mortality risk in COVID-19 Italian patients complicated by acute pulmonary embolism in the short-term period. MethodsThe study was performed in accordance with the Preferred Report Items for Systematic Reviews and Metaanalyses guidelines. PubMed-MEDLINE and Scopus databases were systematically searched for articles, published in the English language and enrolling Italian cohorts with confirmed COVID-19 infection from inception through 20 October 2021. Mortality risk data were pooled using the Mantel-Haenszel random effects models with odds ratio as the effect measure with 95% confidence interval. Heterogeneity among studies was assessed using Higgins and Thomson I 2 statistic.Results Eight investigations enrolling 1.681 patients (mean age 64.9 years, 1125 males) met the inclusion criteria and were considered for the analysis. A random-effect model showed that acute pulmonary embolism was present in 19.0% of Italian patients with COVID-19 infection. Moreover, these patients were at higher mortality risk compared with those without (odds ratio: 1.76, 95% confidence interval: 1.26-2.47, P U 0.001, I 2 U 0%). Sensitivity analysis confirmed yielded results. ConclusionIn Italian patients with COVID-19 infection, acute pulmonary embolism was present in about one out of five and significantly associated with a higher mortality risk in the short-term period. The identification of acute pulmonary embolism in these patients remains critical to promptly identify vulnerable populations who would require prioritization in treatment and prevention and close monitoring.

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Section: Resultsmentioning

confidence: 93%

COVID-19 patients with acute pulmonary embolism have a higher mortality risk: systematic review and meta-analysis based on Italian cohorts

Zuin

Rigatelli

Bilato

et al. 2022

Journal of Cardiovascular Medicine

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“…Specifically, initial reports identified VTE in as many as 35% of patients with COVID-19. 1 , 2 Lung specimens from autopsies of patients with COVID-19 demonstrate widespread thrombosis with capillary microthrombi nine times more prevalent compared with autopsy specimens from patients with severe influenza A. 3 Anticoagulation potentially could decrease thrombotic events.…”

mentioning

confidence: 99%

COUNTERPOINT: Should Therapeutic Heparin Be Administered to Acutely Ill Hospitalized Patients With COVID-19? No

Jiménez

Rali

Doerschug

2022

Chest

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“…Considering these assumptions, 50 % of our patients who underwent CTPA had confirmed PE. [49] Our report had several limitations. First, this was a retrospective, singlecenter study with a small sample size.…”

Section: Prophylaxis and Treatmentmentioning

confidence: 79%

“…[45] The reported rate of positive CTPA in patients with COVID-19 and suspected PE varies widely with estimates ranging from 23% to 50%. [46][47][48][49] This significant variability of the rate of positive CTPA in patients with COVID-19 is likely the consequence of multiple factors: -criteria used to request CTPA, assessment setting, patient's clinical status (critically ill patients who are not stable enough for transfer to the radiology department), degree of thromboprophylaxis. [48,49].…”

Section: Diagnosismentioning

confidence: 99%

“…[15] Although our study probably underestimated the real frequency of PE, because only a small portion, (24 %) of patients underwent CTPA, it is possible to assume that the reduced PE incidence may have been due to the use of a higher-than-prophylactic dose of enoxaparin. [49] Our patients underwent CTPA only if there was a clinical suspicion of PE and/or in the presence of elevated D-dimer levels (> 3000 ng/ml), and if a patient's clinical status allowed for a safe transfer to the radiology department. Considering these assumptions, 50 % of our patients who underwent CTPA had confirmed PE.…”

Section: Prophylaxis and Treatmentmentioning

confidence: 99%

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Pulmonary Embolism in Patients with COVID-19

Scarduelli¹,

Sulzbach²,

Borghi³

2022

JCCI

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Infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) and the resulting syndrome, COVID-19, have been associated with inflammation and a prothrombotic state, with increases in fibrin, fibrinogen, fibrin degradation products and D-dimers. In some studies, elevations in these markers have been associated with worse clinical outcomes. Several studies have demonstrated a high prevalence of venous thromboembolism (VTE), and pulmonary embolism (PE), particularly in patients admitted to the intensive care unit (ICU), even in those receiving prophylactic anticoagulation. The high rate of thrombosis in COVID-19 is driven by at least two interrelated processes: a hypercoagulable state responsible for large-vessel thrombosis and thromboembolism and direct vascular and endothelial injury responsible for in situ microvascular thrombosis. The presence of PE and pulmonary thrombosis may explain why hypoxemia is out of proportion to impairment in lung compliance in some patients with COVID-19 pneumonia. Diagnosing PE in patients with COVID-19 pneumonia may be challenging, because the two pathologies share many signs and symptoms. It has been demonstrated that the administration of prophylactic anticoagulation within 24 h of admission in patients with COVID-19 was associated with decreased mortality when compared with no prophylactic anticoagulation. Given the antithrombotic, anti-inflammatory and possibly antiviral properties of heparins, it has been hypothesized that anticoagulation with heparin administered at doses higher than conventionally used for venous thromboprophylaxis may improve outcomes. In non-critically ill patients hospitalized with COVID-19, therapeutic-dose anticoagulants with heparin (most commonly, low-molecular-weight heparin) increased the probability of survival until hospital discharge with a reduced need for ICU-level organ support at 21 days as compared with usual-care thromboprophylaxis. In Critically ill patients with confirmed COVID-19, therapeutic-dose anticoagulation did not increase the probability of survival to hospital discharge or the number of days free of cardiovascular o respiratory organ support and had a 95% probability of being inferior to usual-care pharmacologic thromboprophylaxis. Currently, randomized trials evaluating the use of tissue plasminogen activator and Tenecteplase in patients with COVID-19 ARDS are underway.

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Pulmonary embolism in patients with severe COVID-19 treated with intermediate- to full-dose enoxaparin: A retrospective study

Cited by 7 publications

References 21 publications

COVID-19 patients with acute pulmonary embolism have a higher mortality risk: systematic review and meta-analysis based on Italian cohorts

COVID-19 patients with acute pulmonary embolism have a higher mortality risk: systematic review and meta-analysis based on Italian cohorts

COUNTERPOINT: Should Therapeutic Heparin Be Administered to Acutely Ill Hospitalized Patients With COVID-19? No

Pulmonary Embolism in Patients with COVID-19

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