High D-dimer values and post-discharge acute pulmonary embolism in young patients with COVID-19: A case series

Abstract

Introduction: The coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with an inflammatory and prothrombotic state that increases the risk of thromboembolic events. High levels of D-dimer are associated with the severity of the disease and acute pulmonary embolism (PE) is the most common thrombotic complication. Material and methods: We analyzed a series of four cases of COVID-19 in young patients (under 45 years) who developed PE with a delay of two to four weeks after hospital discharge. Results: These patients had elevated D-dimer (at least 10 times the upper limit of normal) at the initial admission and at the time of the PE diagnostic, while other parameters which involved inflammation and coagulation (C-reactive protein - CRP; lactate dehydrogenase - LDH; fibrinogen; international normalized ratio - INR) were normal. There were no pre-existing risk factors for PE and all the patients were anticoagulated with prophylactic intermediate doses of enoxaparin. Conclusions: PE is a complication of the COVID-19 disease which may occur later, especially in young patients with no other risk factors for the condition. The highly elevated levels of D-dimer at COVID-19 admission seem to be associated with the post-discharge apparition of PE. This data suggests the role of extended anticoagulation in selected COVID-19 patients and warrants further investigations.

Have the number of pulmonary embolism cases increased during the COVID-19 pandemic?

“…The annual incidence of PE is 39-115 cases per 100,000. mortality has been reported as being 30-35% in untreated patients [3,4]. The coronavirus disease (COViD-19) caused by SARS-CoV-2, started in the last months of 2019, is also associated with an inflammatory and prothrombotic condition that increases the risk of thromboembolic events [5]. The risk of venous thromboembolism increases, especially in those with severe COViD-19, in the presence of cardiovascular disease, obesity, diabetes mellitus, arterial hypertension or other underlying diseases [6].…”

“…acute pulmonary embolism (PE) is the most common thrombotic complication in COViD-19 patients [5]. During the COViD-19 pandemic, curfews were imposed in many countries, and COViD-19 patients were also treated in isolation at the hospital.…”