Development of pulmonary embolism in a nonhospitalized patient with COVID-19 who did not receive venous thromboembolism prophylaxis

Uppuluri, Ellen M; Shapiro, Nancy L.

doi:10.1093/ajhp/zxaa286

Cited by 14 publications

(15 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, it is better to suggest that there may be a potential risk of VTE even in COVID-19 outpatients and not only critically ill patients. Other reports support our findings [ 11 - 12 ]. Although the prophylactic dose is not recommended in non-hospitalized patients [ 10 ], we suggest that outpatients with COVID-19, especially those with reduced mobility, should be regularly contacted and well informed about the possible risk of VTE.…”

Section: Discussionsupporting

confidence: 93%

Bilateral Pulmonary Embolism in Patients Recovered From Asymptomatic COVID-19 Infection

Brem¹,

Rasras²,

Ouafi³

et al. 2021

Cureus

View full text Add to dashboard Cite

Hypercoagulability state is common in patients with coronavirus disease 2019 (COVID-19), especially those requiring intensive care. Indeed, anticoagulation therapy is recommended for all hospitalized COVID-19-patients. Despite well-conducted thromboprophylaxis, so many patients have developed these life-threatening complications. However, these thrombotic events are not known to occur in asymptomatic COVID-19 patients or in those recovered from active severe acute respiratory syndrome coronavirus 2 infection. This case series of a bilateral pulmonary embolism that occurred in patients recovered from asymptomatic COVID-19 highlights the questions about extending thromboprophylaxis in ambulatory patients with COVID-19.

show abstract

Section: Discussionsupporting

confidence: 93%

Bilateral Pulmonary Embolism in Patients Recovered From Asymptomatic COVID-19 Infection

Brem¹,

Rasras²,

Ouafi³

et al. 2021

Cureus

View full text Add to dashboard Cite

show abstract

“…Due to the small numbers taking anticoagulation other than enoxaparin, conclusions regarding differences in the impact of specific anticoagulants could not be made. Current evidence for use of prophylactic anticoagulation in COVID-19 patients is predominantly based on observational studies of inpatient populations [ 29 ], though incidence of pulmonary embolism even in non-hospitalized asymptomatic COVID-19 patients without other predisposing factors for thrombosis suggests that even outpatients could potentially benefit from anticoagulation [ 30 , 31 ]. We found only one anticoagulation study in the LTCF population, a retrospective multi-center case series of 101 Dutch nursing home residents, that reported no significant evidence of mortality benefit with use of oral antithrombotic therapy [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Presentation, Course, and Risk Factors Associated with Mortality in a Severe Outbreak of COVID-19 in Rhode Island, USA, April–June 2020

et al. 2020

View full text Add to dashboard Cite

Long-term care facilities (LTCFs) have had a disproportionally high mortality rate due to COVID-19. We describe a rapidly escalating COVID-19 outbreak among 116 LTCF residents in Rhode Island, USA. Overall, 111 (95.6%) residents tested positive and, of these, 48 (43.2%) died. The most common comorbidities were hypertension (84.7%) and cardiovascular disease (84.7%). A small percentage (9%) of residents were asymptomatic, while 33.3% of residents were pre-symptomatic, with progression to symptoms within a median of three days following the positive test. While typical symptoms of fever (80.2%) and cough (43.2%) were prevalent, shortness of breath (14.4%) was rarely found despite common hypoxemia (95.5%). The majority of patients demonstrated atypical symptoms with the most common being loss of appetite (61.3%), lethargy (42.3%), diarrhea (37.8%), and fatigue (32.4%). Many residents had increased agitation (38.7%) and anxiety (5.4%), potentially due to the restriction measures or the underlying mental illness. The fever curve was characterized by an intermittent low-grade fever, often the first presenting symptom. Mortality was associated with a disease course beginning with a loss of appetite and lethargy, as well as one more often involving fever greater than 38 °C, loss of appetite, altered mental status, diarrhea, and respiratory distress. Interestingly, no differences in age or comorbidities were noted between survivors and non-survivors. Taking demographic factors into account, treatment with anticoagulation was still associated with reduced mortality (adjusted OR 0.16; 95% C.I. 0.06–0.39; p < 0.001). Overall, the clinical features of the disease in this population can be subtle and the symptoms are commonly atypical. However, clinical decline among those who did not survive was often rapid with patients expiring within 10 days from disease detection. Further studies are needed to better explain the variability in clinical course of COVID-19 among LTCF residents, specifically the factors affecting mortality, the differences observed in symptom presentation, and rate of clinical decline.

show abstract

“…The case fatality rate for unselected patients is approximately 2.3% nationally. It was also assumed that most, but not all thromboembolic events and deaths might occur after hospitalization ( 44 , 45 , 46 ).…”

Section: Statistical Considerationsmentioning

confidence: 99%

Rationale and design for the study of rivaroxaban to reduce thrombotic events, hospitalization and death in outpatients with COVID-19: The PREVENT-HD study

Capell

Barnathan

Piazza

et al. 2021

American Heart Journal

View full text Add to dashboard Cite

Background : COVID-19 is associated with both venous and arterial thrombotic complications. While prophylactic anticoagulation is now widely recommended for hospitalized patients with COVID-19, the effectiveness and safety of thromboprophylaxis in outpatients with COVID-19 has not been established. Study Design : PREVENT-HD is a double-blind, placebo-controlled, pragmatic, event-driven phase 3 trial to evaluate the efficacy and safety of rivaroxaban in symptomatic outpatients with laboratory-confirmed COVID-19 at risk for thrombotic events, hospitalization, and death. Several challenges posed by the pandemic have necessitated innovative approaches to clinical trial design, start-up, and conduct. Participants are randomized in a 1:1 ratio, stratified by time from COVID-19 confirmation, to either rivaroxaban 10mg once daily or placebo for 35 days. The primary efficacy endpoint is a composite of symptomatic venous thromboembolism, myocardial infarction, ischemic stroke, acute limb ischemia, non-central nervous systemic embolization, all-cause hospitalization, and all-cause mortality. The primary safety endpoint is fatal and critical site bleeding according to the International Society on Thrombosis and Haemostasis definition. Enrollment began in August 2020 and is expected to enroll approximately 4000 participants to yield the required number of endpoint events. Conclusions : PREVENT-HD is a pragmatic trial evaluating the efficacy and safety of the direct oral anticoagulant rivaroxaban in the outpatient setting to reduce major venous and arterial thrombotic events, hospitalization, and mortality associated with COVID-19.

show abstract

Development of pulmonary embolism in a nonhospitalized patient with COVID-19 who did not receive venous thromboembolism prophylaxis

Cited by 14 publications

References 16 publications

Bilateral Pulmonary Embolism in Patients Recovered From Asymptomatic COVID-19 Infection

Bilateral Pulmonary Embolism in Patients Recovered From Asymptomatic COVID-19 Infection

Clinical Presentation, Course, and Risk Factors Associated with Mortality in a Severe Outbreak of COVID-19 in Rhode Island, USA, April–June 2020

Rationale and design for the study of rivaroxaban to reduce thrombotic events, hospitalization and death in outpatients with COVID-19: The PREVENT-HD study

Contact Info

Product

Resources

About