Pulmonary embolism in COVID-19: Clinical characteristics and cardiac implications - 25/11/20
Abstract |
Background |
The thrombogenic potential of Covid-19 is increasingly recognised. We aim to assess the characteristics of COVID-19 patients diagnosed with pulmonary embolism (PE).
Methods |
We conducted a single centre, retrospective observational cohort study of COVID-19 patients admitted between 1st March and 30th April 2020 subsequently diagnosed with PE following computed tomography pulmonary angiogram (CTPA). Patient demographics, comorbidities, presenting complaints and inpatient investigations were recorded.
Results |
We identified 15 COVID-19 patients diagnosed with PE (median age = 58 years [IQR = 23], 87% male). 2 died (13%), both male patients >70 years. Most common symptoms were dyspnoea (N = 10, 67%) and fever (N = 7, 47%). 12 (80%) reported 7 days or more of non-resolving symptoms prior to admission. 7 (47%) required continuous positive airway pressure (CPAP), 2 (13%) of which were subsequently intubated. All patients had significantly raised D-dimer levels, lactate dehydrogenase (LDH), C-reactive protein (CRP), ferritin and prothrombin times. The distribution of PEs correlated with the pattern of consolidation observed on CTPA in 9 (60%) patients; the majority being peripheral or subsegmental (N = 14, 93%) and only 1 central PE. 10 (67%) had an abnormal resting electrocardiogram (ECG), the commonest finding being sinus tachycardia. 6 (40%) who underwent transthoracic echocardiography (TTE) had structurally and functionally normal right hearts.
Conclusion |
Our study suggests that patients who demonstrate acute deterioration, a protracted course of illness with non-resolving symptoms, worsening dyspnoea, persistent oxygen requirements or significantly raised D-dimer levels should be investigated for PE, particularly in the context of COVID-19 infection. TTE and to a lesser degree the ECG are unreliable predictors of PE within this context.
Le texte complet de cet article est disponible en PDF.Highlights |
• | COVID-19 infection can lead to a procoagulant state, causing the development of pulmonary embolism (PE). |
• | COVID-19 patients who demonstrate acute clinical deterioration and protracted illness should be investigated for PE. |
• | Electrocardiography and transthoracic echocardiogram are of limited help in the immediate diagnosis of PE in these patients. |
Keywords : COVID-19, Coronavirus, Coagulopathy, Pulmonary embolism, Venous thromboembolism
Plan
Vol 38 - N° 10
P. 2142-2146 - octobre 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.