Elsevier

Journal of Critical Care

Volume 61, February 2021, Pages 39-44
Journal of Critical Care

The clinical spectrum of pulmonary thromboembolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: A European case series

https://doi.org/10.1016/j.jcrc.2020.09.021Get rights and content

Highlights

  • Pulnonary thromboembolism (PTE) is a frequent life-threatening complication in patients with COVID-19.

  • The onset of PTE varies from 2 to 4 weeks after the occurrence of the initial symptoms.

  • PTE may occur in patients without past history of risk factors for venous thromboembolism and in those receiving standard prophylactic anticoagulation.

  • Intermediate therapeutic dose of anticoagulants and extend thromboprophylaxis are necessary in these patients after meticulous risk-benefit assessment.

Abstract

Purpose

To describe the clinical characteristics and outcomes of coronavirus disease-2019 (COVID-19)-associated pulmonary thromboembolism (PTE).

Materials and methods

A case series of five patients, representing the clinical spectrum of COVID-19 associated PTE. Patients were admitted to four hospitals in Germany, Italy, and France. Infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was confirmed using a real-time reverse transcription polymerase chain reaction test.

Results

The onset of PTE varied from 2 to 4 weeks after the occurrence of the initial symptoms of SARS-CoV-2 infection and led to deterioration of the clinical picture in all cases. PTE was the primary reason for hospital admission after a 2-week period of self-isolation at home (1 patient) and hospital readmission after initial uncomplicated hospital discharge (2 patients). Three of the patients had no past history of clinically relevant risk factors for venous thromboembolism (VTE). Severe disease progression was associated with concomitant increases in IL-6, ferritin, and D-Dimer levels. The outcome from PTE was related to the extent of vascular involvement, and associated complications.

Conclusion

PTE is a potential life-threatening complication, which occurs frequently in patients with COVID-19. Intermediate therapeutic dose of anticoagulants and extend thromboprophylaxis are necessary after meticulous risk-benefit assessment.

Keywords

SARS-CoV-2
COVID-19
Pulmonary embolism
Thromboprophylaxis
Venous thromboembolism

Cited by (0)

View Abstract