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Pulmonary embolism in coronavirus disease 2019: the silent killer
Vikas Marwah1, Deepu K Peter2, Virender Malik3
1Professor & Head (Pulmonary, Critical Care & Sleep Medicine), Army Institute of Cardiothoracic Sciences (AICTS), Pune, India.
Insights
Coronavirus disease 2019 (COVID-19) significantly increases the risk of pulmonary embolism (PE), a potentially fatal complication. Early diagnosis and anticoagulation are crucial for managing COVID-19 patients, especially those in intensive care units (ICUs).
Area of Science:
- Pulmonology
- Infectious Diseases
- Cardiology
Background:
- Pulmonary embolism (PE) is a severe complication of coronavirus disease 2019 (COVID-19), particularly in intensive care unit (ICU) patients.
- Previous studies highlight the high incidence of PE in COVID-19 patients.
- This study presents a series of 13 PE cases managed at a single institution.
Purpose of the Study:
- To analyze the clinical characteristics, diagnostic methods, and outcomes of pulmonary embolism in COVID-19 patients.
- To emphasize the prothrombotic nature of COVID-19 and the importance of vigilance for PE.
Main Methods:
- Retrospective analysis of medical records for 13 patients diagnosed with PE between February 1, 2020, and September 30, 2020.
- Detailed assessment of clinical, laboratory, and radiological data.
Main Results:
- Pulmonary embolism was diagnosed via computed tomography pulmonary arteriography in 8 patients (61.53%) and clinical findings with imaging/labs in 5 patients (38.46%).
- Five patients required thrombolysis due to hemodynamic instability.
- A significant fatality rate of 30.76% (4 patients) was observed.
Conclusions:
- COVID-19 induces a hypercoagulable state, necessitating heightened clinical suspicion for PE.
- Prophylactic anticoagulation is recommended for all hospitalized COVID-19 patients, with therapeutic regimens for worsening conditions.
- Extended oral anticoagulation for 3-6 months post-discharge is advised for patients with PE.
Background:
Pulmonary embolism (PE) has been identified as one of the deadliest complications of coronavirus disease 2019 (COVID-19), especially in patients admitted to the intensive care unit (ICU). Western literature reminds us of the high prevalence of PE in COVID. Here, we report a series of 13 cases of PE diagnosed and managed at our hospital.
Methods:
Retrospective analysis of medical records of 13 cases of PE admitted at our hospital from February 1, 2020, to September 31, 2020, were done. Their clinical, laboratory, and radiologic data were assessed in detail.
Results:
Computed tomography pulmonary arteriography was used to make the diagnosis in eight patients (61.53%), and clinical findings with corroborative ultrasound and laboratory parameters were used to label PE in five patients (38.46%). Five patients were hemodynamically unstable, requiring thrombolysis with recombinant tissue plasminogen activator, and four patients (30.76%) suffered a fatal outcome.
Conclusion:
COVID-19 is a highly prothrombotic state, and all physicians should keep a high vigilance for PE. All hospitalized patients with COVID-19, especially those admitted in ICU, should be on prophylactic anticoagulation and, if there is any worsening, should be started on therapeutic regimen. Patients at the time of discharge should be switched to oral anticoagulation, which should be continued for at least 3-6 months.
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