Pulmonary embolism severity before and during the COVID-19 pandemic

Abstract

Objectives: Early in the coronavirus 2019 (COVID-19) pandemic, a high frequency of pulmonary embolism was identified. This audit aims to assess the frequency and severity of pulmonary embolism in 2020 compared to 2019. Methods: In this retrospective audit, we compared computed tomography pulmonary angiography (CTPA) frequency and pulmonary embolism severity in April and May 2020, compared to 2019. Pulmonary embolism severity was assessed with the Modified Miller score and the presence of right heart strain was assessed. Demographic information and 30-day mortality was identified from electronic health records. Results: In April 2020, there was a 17% reduction in the number of CTPA performed and an increase in the proportion identifying pulmonary embolism (26%, n = 68/265 vs 15%, n = 47/320, p < 0.001), compared to April 2019. Patients with pulmonary embolism in 2020 had more comorbidities (p = 0.026), but similar age and sex compared to 2019. There was no difference in pulmonary embolism severity in 2020 compared to 2019, but there was an increased frequency of right heart strain in May 2020 (29 vs 12%, p = 0.029). Amongst 18 patients with COVID-19 and pulmonary embolism, there was a larger proportion of males and an increased 30 day mortality (28% vs 6%, p = 0.008). Conclusion: During the COVID-19 pandemic, there was a reduction in the number of CTPA scans performed and an increase in the frequency of CTPA scans positive for pulmonary embolism. Patients with both COVID-19 and pulmonary embolism had an increased risk of 30-day mortality compared to those without COVID-19. Advances in knowledge: During the COVID-19 pandemic, the number of CTPA performed decreased and the proportion of positive CTPA increased. Patients with both pulmonary embolism and COVID-19 had worse outcomes compared to those with pulmonary embolism alone.

Zatorowość płucna wysokiego ryzyka w przebiegu infekcji COVID-19 — bezpieczeństwo i skuteczność systemowej trombolizy

“…The literature describes numerous cases associated with COVID-19 infection and an increased risk of venous thromboembolism (VTE), including PE [1,2]. Coagulopathy in COVID-19 differs from that in sepsis and disseminated intravascular coagulation, where the consumption of platelets and coagulation factors is not common [3].…”

Pulmonary embolism at the emergency department during the COVID-19 pandemic. A comparative cohort study from a tertiary level hospital in southern Spain

“…One of the subgroup analyses carried out in this study compared COVID-19 patients with PE (n = 9) vs. those with no PE (n = 42), and found that none of the patients with PE had right ventricular dysfunction, and right ventricular dimensions were normal, although a higher tricuspid annular plane systolic excursion and increased right ventricular systolic excursion velocity were found in PE patients, presumably due to small sample size and limited severity of embolism. A retrospective study conducted by Tilliridou et al [44] including a total of 1286 CTPAs performed to rule out PE in three hospitals from Scotland. They compared CTPA frequency and PE severity in April and May 2020 versus 2019.…”

SARS-CoV-2 infection, hormonal contraception and pulmonary embolism in a 17-year-old female patient

“…H ypercoagulability, which can lead to formation of blood clots that can travel with blood flow and deposit in pulmonary, cerebral or coronary vessels, is one of the dangerous manifestations of coronavirus disease 2019 (COVID-19) (1) . The global incidence of acute pulmonary embolism (APE), which is the third leading cause of death in Europe, is about 1/1,000 adults per year (2)(3)(4) .…”