Article ; Online: Pulmonary thrombosis in Covid-19: before, during and after hospital admission.
Journal of thrombosis and thrombolysis
2021 Volume 51, Issue 4, Page(s) 978–984
Abstract: ... in association with Covid-19. Also, the thrombotic risk in the pulmonary vasculature is present before and during ... in coronavirus disease 2019 (Covid-19). We evaluated the prevalence of pulmonary thrombosis and reported RV ... from Covid-19. Finally, we observed a case of RV dysfunction and pre-capillary pulmonary ...
| Abstract | Disordered coagulation, endothelial dysfunction, dehydration and immobility contribute to a substantially elevated risk of deep venous thrombosis, pulmonary embolism (PE) and systemic thrombosis in coronavirus disease 2019 (Covid-19). We evaluated the prevalence of pulmonary thrombosis and reported RV (right ventricular) dilatation/dysfunction associated with Covid-19 in a tertiary referral Covid-19 centre. Of 370 patients, positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 39 patients (mean age 62.3 ± 15 years, 56% male) underwent computed tomography pulmonary angiography (CTPA), due to increasing oxygen requirements or refractory hypoxia, not improving on oxygen, very elevated D-dimer or tachycardia disproportionate to clinical condition. Thrombosis in the pulmonary vasculature was found in 18 (46.2%) patients. However, pulmonary thrombosis did not predict survival (46.2% survivors vs 41.7% non-survivors, p = 0.796), but RV dilatation was less frequent among survivors (11.5% survivors vs 58.3% non-survivors, p = 0.002). Over the following month, we observed four Covid-19 patients, who were admitted with high and intermediate-high risk PE, and we treated them with UACTD (ultrasound-assisted catheter-directed thrombolysis), and four further patients, who were admitted with PE up to 4 weeks after recovery from Covid-19. Finally, we observed a case of RV dysfunction and pre-capillary pulmonary hypertension, associated with Covid-19 extensive lung disease. We demonstrated that pulmonary thrombosis is common in association with Covid-19. Also, the thrombotic risk in the pulmonary vasculature is present before and during hospital admission, and continues at least up to four weeks after discharge, and we present UACTD for high and intermediate-high risk PE management in Covid-19 patients. |
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| MeSH term(s) | COVID-19/blood ; COVID-19/complications ; COVID-19/mortality ; COVID-19/therapy ; Computed Tomography Angiography/methods ; Female ; Fibrin Fibrinogen Degradation Products/analysis ; Heart Ventricles/diagnostic imaging ; Heart Ventricles/pathology ; Humans ; Hypoxia/etiology ; Hypoxia/therapy ; Male ; Middle Aged ; Organ Size ; Outcome and Process Assessment, Health Care ; Pulmonary Embolism/diagnostic imaging ; Pulmonary Embolism/etiology ; Pulmonary Embolism/physiopathology ; Risk Assessment ; Risk Factors ; SARS-CoV-2 ; Thrombolytic Therapy/methods ; Ultrasonography, Interventional/methods ; United Kingdom ; Ventricular Dysfunction, Right/diagnosis ; Ventricular Dysfunction, Right/etiology ; Ventricular Dysfunction, Right/physiopathology |
| Chemical Substances | Fibrin Fibrinogen Degradation Products ; fibrin fragment D |
| Language | English |
| Publishing date | 2021-01-01 |
| Publishing country | Netherlands |
| Document type | Journal Article |
| ZDB-ID | 1230645-9 |
| ISSN | 1573-742X ; 0929-5305 |
| ISSN (online) | 1573-742X |
| ISSN | 0929-5305 |
| DOI | 10.1007/s11239-020-02370-7 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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