Asian Institute of Research, Journal Publication, Journal Academics, Education Journal, Asian Institute
Asian Institute of Research, Journal Publication, Journal Academics, Education Journal, Asian Institute

Journal of Health and Medical Sciences

ISSN 2622-7258

Screen Shot 2018-08-12 at 1.24.09 AM.png
Screen Shot 2018-08-12 at 1.24.02 AM.png
Screen Shot 2018-08-12 at 1.23.57 AM.png
Screen Shot 2018-08-12 at 1.23.52 AM.png
crossref
doi
open access

Published: 03 September 2021

Pulmonary Embolism Detection in COVID-19 Patients

Priyancaa Jeyabaladevan, Sharenja Jeyabaladevan

Havering and Redbridge University Trust, Chelsea and Westminster Hospital NHS Foundation Trust

journal of social and political sciences
pdf download

Download Full-Text Pdf

doi

10.31014/aior.1994.04.03.178

Pages: 50-57

Keywords: Coronavirus Disease 2019, COVID-19, Pulmonary Embolism, CTPA

Abstract

Background: A clinically important impact of Coronavirus Disease 2019 (COVID-19) is the increased likelihood of thromboembolism, mainly pulmonary embolism (PE). To screen for these complications a biochemical marker, D-dimer, is usually done. There is a plethora of research validating the use of D-dimer cutoff levels in non-COVID-19 patients, however less so in the COVID-19 population. Aim: To determine the number of suspected COVID patients with D-dimer ≥ 0.5 and PE reported on CTPA. Methods: Non-interventional single-centre retrospective clinical correlational study. Patient cohort was patients admitted with suspected COVID-19 over a 5-week period. N=690. Results: 76.5% of suspected COVID-19 patients were PCR positive. 40% of these patients had a CTPA completed with 19% reported to have a PE. 52% of patients had a D-dimer value ≥ 0.5 10.6% patients had a PE with a D-dimer ≥ 0.5. Conclusion: Nationally, hospitals are adopting existing D-dimer cut off levels to rule out PEs, however this leads to a large proportion of admitted COVID-19 patients having possibly unnecessary computed tomography pulmonary angiogram. This study highlights that majority of patients with D-dimers above the cut off level have negative PEs and contributes to the notion that standard D-dimer cutoffs are insufficiently accurate to be used as a standalone test in diagnosis in the context of an underlying SARS-CoV-2 infection.

References

  1. Schulman, Sam et al. “Venous Thromboembolism in COVID-19.” Thrombosis and haemostasis vol. 120,12 (2020): 1642-1653. doi:10.1055/s-0040-1718532

  2. Al-Ani F, Chehade S, Lazo-Langner A. Thrombosis risk associated with COVID-19 infection. A scoping review. Thromb Res. 2020;192:152–160.

  3. Huang C, Wang Y, Li X.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China Lancet 2020395(10223):497–506

  4. Chen N, Zhou M, Dong X.Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study Lancet 2020395(10223):507–513.

  5. Danzi G B, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association? Eur Heart J. 2020;41(19):1858

  6. Minet C, Potton L, Bonadona A. Venous thromboembolism in the ICU: main characteristics, diagnosis and thromboprophylaxis. Crit Care. 2015;19:287.

  7. Malato A, Dentali F, Siragusa S. The impact of deep vein thrombosis in critically ill patients: a meta-analysis of major clinical outcomes. Blood Transfus. 2015;13(04):559–568.

  8. Abou-Ismail M Y, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management. Thromb Res. 2020;194:101–115.

  9. Qin C, Zhou L, Hu Z. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020;71(15):762–768.

  10. Levi M, van der Poll T, Büller H R. Bidirectional relation between inflammation and coagulation. Circulation. 2004;109(22):2698–2704.

  11. Xu X W, Wu X X, Jiang X G. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020;368:m606.

  12. Vaughan C J, Cronin H, Ryan P M, Caplice N M. Obesity and COVID-19: a Virchow's triad for the 21st century. Thromb Haemost. 2020 doi: 10.1055/s-0040-1714216.

  13. CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis) . Helms J, Tacquard C, Severac F. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020;46(06):1089–1098.

  14. Terpos E, Ntanasis-Stathopoulos I, Elalamy I. Hematological findings and complications of COVID-19. Am J Hematol. 2020;95(07):834–847.

  15. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(04):844–847.

  16. Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020;18(06):1421–1424.

  17. Jin S, Jin Y, Xu B, Hong J, Yang X. Prevalence and impact of coagulation dysfunction in COVID-19 in China: a meta-analysis. Thromb Haemost. 2020 doi: 10.1055/s-0040-1714369.

  18. Middeldorp S, Coppens M, van Haaps T F. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 2020;18(08):1995–2002.

  19. van der Hulle T, Cheung WY, Kooij S, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet 2017;390:289-297.

  20. Rosovsky RP, Grodzin C, Channick R, et al.Diagnosis and Treatment of Pulmonary Embolism During the Coronavirus Disease 2019 Pandemic: A Position Paper From the National PERT Consortium. Chest 2020; 158:

  21. 2021. [online] Available at: <https://www.mdcalc.com/years-algorithm-pulmonary-embolism-pe#next-steps> [Accessed 8 August 2021].

  22. Mouhat B, Besutti M, Bouiller K, et al. Elevated D-dimers and lack of anticoagulation predict PE in severe COVID-19 patients. Eur Respir J 2020; 56: 2001811. doi:10.1183/13993003.01811-2020