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Pulmonary Embolism in COVID-19 Patients: Awareness of an Increased Prevalence

Key Points:

The authors report an experience of high risk of pulmonary embolism in the setting of COVID – 19 ICU patients – the details of their preliminary observation follow.

  • Reported population: 197 confirmed COVID – 19 patients with an ICU Pneumonia admission.
  • Pulmonary Embolus (PE) was diagnosed in 20.6% within 1-18 days, medial 6 days during the ICU admission.
  • A Comparison group of 196 patients from the same period in 2019 had a 6.1% incidence of PE.
  • Thus, the COVID – 19 population showed an absolute increase in the PE incidence of 14.4%.
  • A second comparison noted the risk of PE (7.5%) was half as frequent in 40 ICU admissions for Influenza in late 2019.
  • COVID – 19 patients D-Dimers, plasma factor VIII activity and factor Willebrand antigen levels consistent with an increased risk of PE.
  • When diagnosed with PE, 20/22 COVID – 19 patients were on Guideline recommended prophylactic antithrombotic treatment (UFH, LMWH). In addition, one patient was on UFH for atrial fibrillation and one patient was on therapeutic fluindione (a vitamin K antagonist) for DVT.
  • The associated incidence of DVT was lowest in the COVID – 19 group compared to the other two groups.
  • The report has potential biases – first, the decision to perform Computer Tomography Pulmonary Angiography was based on clinical decisions, not for the entire populations: in addition, the population tends to be obese which could impact results.
  • In summary, this preliminary report form France suggests that ICU patients with COVID -19 infection are at significantly increased risk for acute PE despite prophylactic anticoagulants.