Pulmonary embolism in patients with the Coronavirus Disease 2019
DOI:
https://doi.org/10.20883/medical.e602Keywords:
Coronavirus, COVID-19, SARS-COV2, pulmonary embolism, coagulation abnormalitiesAbstract
Coronaviruses are RNA viruses causing infectious diseases. They had been responsible for 15% cases of a common cold before December 2019. With the new strain of coronavirus SARS CoV2 which causes COVID-19 disease, the ongoing pandemic surprised with the severity of symptoms and its course compared to the previously known mild respiratory tract infections. In the end of December 2021, over 274 million people were diagnosed with COVID-19 disease, and the total mortality amounted to nearly 5.4 million deaths in more than 200 countries. One of the potentially fatal complications of COVID-19 is pulmonary embolism (PE). It appears that PE has been associated with several coagulation abnormalities as well as with frequent significantly elevated concentration of D‑dimer's. A higher D‑dimer concentration in blood serum, in turn, has been associated with an increased risk of premature death. Moreover, inflammation, typical in the course of COVID-19, is considered a prothrombotic condition; higher interleukin 6 (Il-6) and C‑reactive protein concentrations have been found in patients with more severe forms of COVID-19. So far, none specific for COVID-19 studies have been available with regard to the diagnosis and treatment of PE. Therefore, the practical approach is based on the experience of other groups of patients. Prevention of thrombotic events seems reasonable, at least in COVID-19 patients with the risk factors of developing venous thromboembolism. Low‑molecular‑weight heparins are most commonly prescribed (e.g. enoxaparin, dalteparin). Following the confirmed definite PE diagnosis, proper anticoagulation or, if necessary, thrombolytic treatment must be introduced.
Downloads
References
European Centre for Disease Prevention and Control. General Informations. Common Human Coronaviruses – https://www.cdc.gov/coronavirus/general-information.html
Almeida JD, Tyrrell DA. The morphology of three previously uncharacterized human respiratory viruses that grow in organ culture. J Gen Virol. 1967; 1: 175–178.
Tyrrell DA, Bynoe ML. Cultivation of a novel type of common-cold virus in organ cultures. Br Med J. 1965;1:1467-1470.
Corman VM, Muth D, Niemeyer D, Drosten C. Hosts and Sources of Endemic Human Coronaviruses. Adv Virus Res. 2018;100:163-188.
Su S, Wong G, Shi W, et al. Epidemiology, Genetic Recombination, and Pathogenesis of Coronaviruses. Trends Microbiol. 2016; 24: 490-502. //
Liu DX, Liang JQ, Fung TS. Human Coronavirus-229E, -OC43, -NL63, and -HKU1 (Coronaviridae). Encyclopedia of Virology. 2021: 428-440.
Azhar EI, Hui DSC, Memish ZA et al. The Middle East Respiratory Syndrome (MERS). Infect Dis Clin North Am. 2019; 33: 891-905.
Chan-Yeung M, Xu RH. SARS: epidemiology. Respirology. 2003; 8 Suppl(Suppl 1): 9-14.
COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). https://www.arcgis.com/apps/opsdashboard/index.html
Oxford University. Our world in data. https://ourworldindata.org/
Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol 2020; 5; 536–544.
Chen N, Zhou M, Dong X et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395: 507-513
Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. J Med Virol. 2020; 92: 401–402.
Lechien JR, Chiesa-Estomba CM, Place S et al; COVID-19 Task Force of YO-IFOS. Clinical and epidemiological characteristics of 1420 European patients with mild-to-moderate coronavirus disease J Intern Med. 2020; 288: 335-344.
Cheng, C., Zhang, D., Dang, D. et al. The incubation period of COVID-19: a global meta-analysis of 53 studies and a Chinese observation study of 11 545 patients. Infect Dis Poverty 10, 119 (2021).
Marschner, I.C. Estimating age-specific COVID-19 fatality risk and time to death by comparing population diagnosis and death patterns: Australian data. BMC Med Res Methodol 21, 126 (2021).
Vakili K, Fathi M, Pezeshgi A et al. Critical complications of COVID-19: A descriptive meta-analysis study. Rev Cardiovasc Med. 2020; 21: 433-442.
Sakr Y, Giovini M, Leone M et al. Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review. Ann Intensive Care. 2020; 10: 124 (1-13).
Bompard F, Monnier H, Saab I et al. Pulmonary embolism in patients with COVID-19 pneumonia. Eur Respir J. 2020; 56: 2001365 (1-4)
Liao SC, Shao SC, Chen YT et al. Incidence and mortality of pulmonary embolism in COVID-19: a systematic review and meta-analysis. Crit Care. 2020;1:464 (1-5)
Tang Y, Liu J, Zhang D et al. Cytokine Storm in COVID-19: The Current Evidence and Treatment Strategies. Front Immunol. 2020; 11: 1708.
Mai F, Del Pinto R, Ferri C. Covid-19 and cardiovascular diseases. J. Cardiol. 2020 Nov;76(5):453-458
Becker RC. COVID-19 update: COVID-19-associated coagulopathy. J Thromb Thrombolysis. 2020; 50: 54–67.
Henry BM, Vikse J, Benoit S et al. Hyperinflammation and derangement of renin-angiotensin-aldosterone system in COVID-19: A novel hypothesis for clinically suspected hypercoagulopathy and microvascular immunothrombosis. Clin Chim Acta. 2020; 507: 167-173.
Han H, Yang L, Liu R et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med. 2020; 58: 1116–1120.
Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-Lancet Haematol. 2020; 7: 438-440.
Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-J Thromb Haemost. 2020; 18: 1559-1561.
Ranucci M, Ballotta A, Di Dedda U et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J Thromb Haemost. 2020; 18: 1747-1751.
Paliogiannis P, Mangoni AA, Dettori P et al. D-Dimer Concentrations and COVID-19 Severity: A Systematic Review and Meta-Analysis. Front Public Health. 2020; 8: 432.
Zhou F, Yu T, Du R et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 10229: 1054-1062.
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: 844-847.
Smeeth L, Cook C, Thomas S et al. Risk of deep vein thrombosis and pulmonary embolism after acute infection in a community setting. Lancet. 2006; 9516: 1075-1079.
Shang J, Wang Q, Zhang H et al. The Relationship Between Diabetes Mellitus and COVID-19 Prognosis: A Retrospective Cohort Study in Wuhan, China. Am J Med. 2021 Jan 134 : 6-14
Poissy J, Goutay J, Caplan M et al. Lille ICU Haemostasis COVID-19 Group. Pulmonary Embolism in Patients With COVID-19: Awareness of an Increased Prevalence. Circulation. 2020; 142: 184-186.
Grillet F, Behr J, Calame P, et al. Acute pulmonary embolism associated with COVID-19 pneumonia detected with pulmonary CT angiography. Radiology 2020; 296: 186–188.
Poyiadji N, Cormier P, Patel PY et al. Acute Pulmonary Embolism and COVID-Radiology. 2020; 297: 335-338.
Helms J, Tacquard C, Severac F et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020; 46: 1089-1098.
Lodigiani C, Iapichino G, Carenzo L. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020; 191: 9–14.
Klok FA, Kruip MJHA, van der Meer NJM et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thromb Res. 2020; 191: 148-150.
Thomas W, Varley J, Johnston A, et al. Thrombotic complications of patients admitted to intensive care with COVID-19 at a teaching hospital in the United Kingdom. Thromb Res. 2020; 191: 76-77.
Middeldorp S, Coppens M, van Haaps TF. Incidence of venous thromboembolism in hospitalised patients with COVID-J Thromb Haemost. 2020; 18: 1995–2002.
Ullah W, Saeed R, Sarwar U, et al. COVID-19 complicated by acute pulmonary embolism and right-sided heart failure. JACC Case Rep. 2020; 9: 1379-1382.
Abernethy K, Sivakumar P, Patrick T, et al. Coexistent COVID-19 pneumonia and pulmonary embolism: challenges in identifying dual pathology. Thorax. 2020; 75: 812-814.
Casey K, Iteen A, Nicolini R, Auten J. COVID-19 pneumonia with hemoptysis: Acute segmental pulmonary emboli associated with novel coronavirus infection. Am J Emerg Med. 2020; 38: 1544-1544.
Tamburello A, Bruno G, Marando M. COVID-19 and pulmonary embolism: not a coincidence. Eur J Case Rep Intern Med. 2020;7:001692 (1-4)
Motwani M. Abrupt deterioration and pulmonary embolism in COVID-19: a case report. Clin Med (Lond). 2020;20:95-96.
Vadukul P, Sharma DS, Vincent P. Massive pulmonary embolism following recovery from COVID-19 infection: inflammation, thrombosis and the role of extended thromboprophylaxis. BMJ Case Rep. 2020; 13: e238168.
Polat V, Bostancı Gİ. Sudden death due to acute pulmonary embolism in a young woman with COVID‐J Thromb Thrombolysis. 2020; 50: 239‐ 241.
Mazo J, Singh S, Khan Z et al. More than Just Pneumonia: Acute Pulmonary Embolism in Two Middle-Aged Patients with COVID-Case Rep Med. 2020; 2020; 4812036 (1-5)
Kirsch B, Aziz M, Kumar S, et al. Wells Score to Predict Pulmonary Embolism in Patients with Coronavirus Disease Am J Med. 2021;134:688-690.
Sabri A, Davarpanah AH, Mahdavi A, et al. Novel coronavirus disease 2019: predicting prognosis with a computed tomography–based disease severity score and clinical laboratory data. Pol Arch Intern Med. 2020; 130: 629-634.
Ai T, Yang Z, Hou H et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020;296:E32-E40
Sacharczuk, W., Dankowski, R. , Marciniak, A., Szałek-Goralewska, A. and Szyszka, A. Cardiovascular imaging in the acute phase of coronavirus disease 2019 (COVID-19). Journal of Medical Science. 90, 3 (Sep. 2021), e532.
McConnell MV, Solomon SD, Rayan ME, et al. Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. Am J Cardiol. 1996; 78: 469–473.
Grifoni S, Olivotto I, Cecchini P, et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation. 2000; 101: 2817–2822.
Massoomi MR, Anderson RD, Ahmed MM et al. Cardiovascular Considerations for the Internist and Hospitalist in the COVID-19 Era. Am J Med. 2020; 133 ; 1254-1261.
Cui LY, Cheng WW, Mou ZW, Xiao D, Li YY, Li YJ, Li WT, Chen ZM. Risk factors for pulmonary embolism in patients with COVID-19: a systemic review and meta-analysis. Int J Infect Dis. 2021 Oct;111:154-163.
Manolis AS, Manolis TA, Manolis AA, et al. COVID-19 Infection: Viral Macro- and Micro-Vascular Coagulopathy and Thromboembolism/Prophylactic and Therapeutic Management. J Cardiovasc Pharmacol Ther. 2021 Jan;26(1):12-24.
Kolanko E, Senderek T, Prokop-Staszecka A, et al. Thromboprophylaxis in hospitalized COVID-19 patients: the efficacy and safety of the approved hospital protocol. Pol Arch Intern Med. 2021; 131
Prandoni P, Cattelan AM, Carrozzi L et al. The hazard of fondaparinux in non-critically ill patients with COVID-19: Retrospective controlled study versus enoxaparin, Thromb Res. 2020; 196: 395-397.
Schiavone M, Gasperetti A, Mancone M et al. Oral anticoagulation and clinical outcomes in COVID-19: An Italian multicenter experience. Int J Cardiol. 2021; 323: 276-280.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 The copyright to the submitted manuscript is held by the Author, who grants the Journal of Medical Science (JMS) a nonexclusive licence to use, reproduce, and distribute the work, including for commercial purposes.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
