Pulmonary embolism: A complication of COVID 19 infection

Akel, Tamer; Qaqa, Firas; Abuarqoub, Ahmad; Shamoon, Fayez

doi:10.1016/j.thromres.2020.05.033

Cited by 33 publications

(31 citation statements)

References 12 publications

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“…Evidence suggests that SARS-CoV-2 infections are associated with frequent activation of the coagulation system, and COVID-19 disease has been associated with high rates of venous thromboembolism and particularly acute pulmonary embolism. [20][21][22] Moreover, autopsy studies have proposed that the inflammatory process in the microcirculation of the lung may cause in situ immunothrombi, providing an alternative explanation to the conventional thromboembolic mechanism of pulmonary embolism. One study suggested that lungs from COVID-19 patients show severe endothelial injury associated with intracellular virus and disrupted cell membranes, and that alveolar capillary microthrombi were 9 times as prevalent in COVID-19 patients as in patients with influenza.…”

Section: Discussionmentioning

confidence: 99%

The Spectrum of Histopathologic Findings in Lungs of Patients With Fatal Coronavirus Disease 2019 (COVID-19) Infection

Roden

Bois

Johnson

et al. 2020

Archives of Pathology &Amp; Laboratory Medicine

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Context: Respiratory failure appears to be the ultimate mechanism of death in most patients with severe COVID-19 infection. Studies of postmortem COVID-19 lungs largely report diffuse alveolar damage (DAD) and capillary fibrin thrombi, but we have also observed other patterns. Objective: To report demographic and radiographic features along with macroscopic, microscopic, and microbiologic postmortem lung findings in patients with COVID-19 infections. Design: Patients with confirmed COVID-19 infection and postmortem examination (3/2020–5/2020) were included. Clinical findings were abstracted from medical records. Lungs were microscopically reviewed independently by 4 thoracic pathologists. Imaging studies were reviewed by a thoracic radiologist. Results: Eight patients (7 men, 87.5%; median age of 79 years, range, 69–96) died within a median of 17 days (range, 6–100) from onset of symptoms. The median lung weight was 1,220 g (range, 960–1,760); consolidations were found in 5 of 8 (62.5%) patients; gross thromboemboli were noted in one of 8 (12.5%) patient. Histologically, all patients had acute bronchopneumonia, 6 of 8 (75%) patients had also DAD. Two of 8 (25%) patients had aspiration pneumonia in addition. Thromboemboli, usually scattered and rare, were identified in 5 of 8 (62.5%) patients in small vessels and in two of these patients also in pulmonary arteries. Four of (50%) patients had perivascular chronic inflammation. Postmortem bacterial lung cultures were positive in 4 of 8 (50%) patients. Imaging studies (available in 4 patients) were typical (N=2, 50%), indeterminate (N=1, 25%), or negative (N=1, 25%) for COVID-19 infection. Conclusions: Our study shows that patients infected with COVID-19 not only have DAD but also commonly have acute bronchopneumonia and aspiration pneumonia. These findings are important for management of these patients.

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Section: Discussionmentioning

confidence: 99%

The Spectrum of Histopathologic Findings in Lungs of Patients With Fatal Coronavirus Disease 2019 (COVID-19) Infection

Roden

Bois

Johnson

et al. 2020

Archives of Pathology &Amp; Laboratory Medicine

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“…Although there was no clear evidence to treat SARS-CoV-2 infection hydroxychloroquine / chloroquine [ 14 ], ivermectin [ 26 ], lopinavir / ritonavir [ 27 ], and anti-interleukin agents were reported to be potentially effective [ 11 ]. Since thrombotic disorders were also reported as one of the critical manifestations [ 28 , 29 ], we used various combinations of drugs and anticoagulant therapies in Group S patients ( Table 3 ). Group M patients received favipiravir and ciclesonide, and all of them successfully recovered; however, we cannot make any conclusions regarding the drugs’ efficacy from this study due to lack of randomized, placebo control design.…”

Section: Discussionmentioning

confidence: 99%

Characteristics, laboratories, and prognosis of severe COVID-19 in the Tokyo metropolitan area: A retrospective case series

Mori

Otomo

2020

PLoS ONE

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The impact of the COVID-19 pandemic has been immense, while the epidemiology and pathophysiology remain unclear. Despite many casualties in many countries, there have been less than 1,000 deaths in Japan as of end of June, 2020. In this study, we analyzed the cases of COVID-19 patients admitted to our institution located in the Tokyo metropolitan area where the survival rate is higher than those in other cities in the world. Medical records of COVID-19 patients that were admitted to a single Japanese tertiary university hospital in the Tokyo metropolitan area between March 10th and June 2nd, 2020 were retrospectively reviewed. The identified COVID-19 cases were subdivided into two groups (severe and mild) depending on the need for mechanical ventilation. Those in the severe group required mechanical ventilation as opposed to those in the mild group. The data were analyzed using nonparametric tests expressed by median [interquartile range (IQR)]. A total of 45 COVID-19 patients were included, consisting of 22 severe cases (Group S) and 23 mild cases (Group M). Male sex (Group S, 95.5% vs. Group M, 56.5%, p<0.01), high body mass index (Group S, 24.89 [22.44-27.15] vs. Group M, 21.43 [19.05-23.75], p<0.01), and hyperlipidemia (Group S, 36.4% vs. Group M, 0%, p<0.01) were more seen in Group S. Five (22.7%) cases in Group S underwent extracorporeal membranous oxygenation (ECMO). On admission, lymphopenia, decreased albumin, and elevated fibrinogen, lactate dehydrogenase, transaminases, creatine kinase, C-reactive protein, and procalcitonin were observed in Group S. The median ICU and hospital stay were 13.5 [10.3-22.3] days and 23.0 [16.3-30.5] days, respectively, in Group S. As of June 28th, 2020, in Group S, 19 (86.4%) patients have survived, of which 17 (77.3%) were discharged, and 2 are still in treatments. Three died of multiple organ failure. All 23 patients in Group M have recovered. Male sex, high body mass index, and hyperlipidemia can be risk factors for severe COVID-19 pneumonia, and its overall short-term survival rate was between 77.3% and 86.4% in this study.

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“…VTE rates in outpatients with COVID-19 or immediately after hospital discharge following treatment for COVID-19 have not been described. 7 Akel et al 14 reported a case series of 6 patients with COVID-19 (5 were 40 years of age or older and 1 was 28 years old) who were not critically ill or affected by major risk factors for VTE and mostly presented with a PE at the time of diagnosis of COVID-19 (1 patient presented with PE 10 days following an admission for COVID-19). That case series highlights the possibility of VTE in noncritically ill patients with COVID-19.…”

Section: Discussionmentioning

confidence: 99%

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

Uppuluri

Shapiro

2020

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Coronavirus disease 2019 (COVID-19) has been associated with thrombotic complications such as stroke and venous thromboembolism (VTE), and VTE prophylaxis for hospitalized patients with COVID-19 is recommended. However, extended postdischarge VTE prophylaxis and VTE prophylaxis for nonhospitalized patients with COVID-19 are not routinely recommended due to uncertain benefit in these populations. Summary Here we report development of a pulmonary embolism (PE) in a young patient without other VTE risk factors who was treated for COVID-19 in an emergency department (ED) and discharged home without VTE prophylaxis, which was consistent with current recommendations. The patient presented to the ED 12 days later with complaints of chest pain for 1 day and was found to have a PE within the segmental and subsegmental branches of the left lower lobe. Conclusion This case suggests that nonhospitalized patients with COVID-19 may be at higher risk for VTE than patients with other medical illnesses and warrants further research into the risk of VTE in outpatients with COVID-19.

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Pulmonary embolism: A complication of COVID 19 infection

Cited by 33 publications

References 12 publications

The Spectrum of Histopathologic Findings in Lungs of Patients With Fatal Coronavirus Disease 2019 (COVID-19) Infection

The Spectrum of Histopathologic Findings in Lungs of Patients With Fatal Coronavirus Disease 2019 (COVID-19) Infection

Characteristics, laboratories, and prognosis of severe COVID-19 in the Tokyo metropolitan area: A retrospective case series

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

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