A daily clinical challenge during the COVID-19 pandemic era: How to treat patients with pulmonary embolism and hemoptysis

Abstract

Introduction/Objective Pulmonary embolism (PE) is a relatively common complication of COVID-19. The results of a study published in 2022 show that 10-15% of hospitalized patients suffer from prothrombotic coagulopathy, resulting in arterial or venous thromboembolic events. We are presenting a COVID-19 patient with PE whose treatment was a challenge because he had developed hemoptysis after being treated with anticoagulant therapy. Case report. We presented a case of a young patient with COVID-19 induced pneumonia, treated with antibiotics, corticosteroids and prophylactic anticoagulant therapy. During his hospitalization, he developed PE which was why the dosage of anticoagulants was increased. Not long after that, the patient developed massive hemoptysis. A team of specialists decided that he was to continue receiving the anticoagulant therapy while simultaneously introducing a hemostatic drug. The patient responded well to the expanded therapy and was discharged from the hospital two weeks later. Conclusion. Based on all pre-COVID medical guidelines, the cornerstone of treating PE is anticoagulant therapy. However, even taking into account significant advances in creating innovative drugs and the absolute clinical necessity of prescribing such therapy, it still comes with a series of complications, the most important of which is significant bleeding. Treating patients with comorbidities, PE and hemoptysis is a complex endeavour, because what helps with one disease may worsen another and vice versa. This is why an individualized treatment approach is necessary for each patient and difficult decisions should be made by a team of specialists.