Arterial and venous thromboembolic complications of COVID-19 detected by CT angiogram and venous duplex ultrasound

Abstract

Objective To investigate the incidence of thromboembolic events, specifically pulmonary embolism (PE), deep vein thrombosis (DVT), and cerebrovascular accidents (CVA), in patients who tested positive for COVID-19 through RT-PCR in a regional healthcare system in Connecticut. Materials and methods All CT angiogram (CTA) and venous duplex extremity ultrasound (US) examinations performed on 192 consecutively documented cases of COVID-19 were retrospectively reviewed at a multi-centered healthcare system. Clinical characteristics and patient outcomes were evaluated and compared between two groups based on the presence or absence of acute thromboembolic events. Results Of the 16,264 patients tested for COVID-19, 3727 (23%) were positive. Out of those, 192 patients underwent 245 vascular imaging studies including chest CTA (86), venous duplex ultrasound (134), and CTA head and neck (25). Among those who underwent imaging, 49 (26%) demonstrated acute thromboembolic events which included 13/86 (15%) with PE, 34/134 (25%) with DVT, and 6/25 (24%) with CVA. One patient had positive results on all 3 examinations, and 2 patients had positive results on both chest CTA and venous duplex US. Males were more likely to have a thromboembolic event than females (33/103 (34%) vs. 14/89 (16%), p = 0.009). No significant difference was observed with respect to age, cardiopulmonary comorbidities, malignancy history, diabetes, or dialysis. Conclusion Approximately 26% of COVID-19 patients with positive testing who underwent vascular imaging with CTA or venous duplex ultrasound had thromboembolic events including PE, DVT, and CVA. This indicates that COVID-19 patients are at increased risk for thromboembolic complications.

Pulmonary thromboembolic events in COVID‐19—A systematic literature review

“…In total, 32 hospital cohort and database studies with follow-up ranging from 6.8 days (median duration of hospitalization) to 198 days (maximum follow-up period for patients in hospital at the end of the enrollment period) were included in the literature review (Table 1). Of these, 26 studies described analyses of hospital (or multi-hospital) records, and included outpatients (three studies), [8][9][10] patients treated in emergency departments (EDs; two studies) 11,12 and patients treated in hospital (22 studies) 8,10,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] ; six studies described cohorts treated in ICU. 10,15,17,24,26,32 A single study followed patients discharged after hospitalization for COVID-19.…”

“…Across the included studies, PE was reported by a median of 0.4% of outpatients, [7][8][9][10][11][12][36][37][38] 2.3% of patients admitted to hospital, 8,10,[13][14][15][16][18][19][20][21][22][23][25][26][27][28][29][30][31][32][33][34][35]37 and 7.3% of patients treated in ICU 15,17,24,26,32 (Figure 2a). In analyses of patients who all underwent CTPA, PE was reported by a median of 34.2% of outpatients treated in ED, 11,12 8.3% of previously discharged outpatients (in a single study), 7 18.5% of hospitalized patients, 9,13,18,21,27,29,31 22.1% of hospitalized non-ICU ...…”

Vascular findings in CTA body and extremity of critically ill COVID-19 patients: commonly encountered vascular complications with review of literature

“…[14]. In our review, 12 studies found an incidence of PE ranging from 2.8 to 57%, with patients admitted to the ICU experiencing PE at significantly higher rates [3,5,[15][16][17][18][19][20][21][22][23][24]. Though isolated COVID-19 infection represented the most common indication for CTPA imaging request, clinically apparent dyspnea, hypoxia or increasing oxygen requirement, chest pain, hemoptysis, and tachycardia, as well as elevated D-dimer, were the most common indications for additional imaging [22].…”

Musculoskeletal Manifestations of COVID-19: Currently Described Clinical Symptoms and Multimodality Imaging Findings

“…Most cases of COVID-19–related DVT have been described in the lower extremities, either in the calf musculature and popliteal vein or the femoral vein with central propagation. Classic findings of acute venous thrombosis are best diagnosed at gray-scale and color and spectral Doppler US ( 38 ).…”

“…CT angiography is the study of choice to help diagnose arterial thrombosis, with classic imaging findings well described in the literature ( 38 ). Simultaneous imaging of the contralateral extremity may help to detect subtle abnormalities ( Fig 11 ).…”