Pulmonary Embolism in Post-CoviD-19 Patients, a Literature Review: Red Flag for Increased Awareness?

Mouzarou, Angeliki; Ιωάννου, Μαρία; Leonidou, Elena; Chaziri, Ioanna

doi:10.1007/s42399-022-01273-3

Cited by 18 publications

(13 citation statements)

References 69 publications

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“…Indirect signs of pulmonary vessel microthrombosis were investigated in a wide series of 767 patients studied 3 months after the acute phase [ 29 ]. Impaired lung diffusion was found in 17% of the patient population, and many case reports of pulmonary embolism were reported in long-COVID patients [ 30 ]. Pulmonary angiogram in long-COVID patients has been suggested following a specific algorithm based on persistence of respiratory symptoms, lung diffusion tests, and perfusion imaging [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

The Long Term Residual Effects of COVID-Associated Coagulopathy

Ranucci

Baryshnikova

Anguissola

et al. 2023

IJMS

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During the acute phase of COVID-19, many patients experience a complex coagulopathy characterized by a procoagulant pattern. The present study investigates the persistence of hemostatic changes in post-COVID patients at a long-term follow up, and the link with the persistence of physical and neuropsychological symptoms. We completed a prospective cohort study on 102 post-COVID patients. Standard coagulation and viscoelastic tests were performed, along with an assessment of persistent symptoms and recording of acute phase details. A procoagulant state was adjudicated in the presence of fibrinogen > 400 mg/dL, or D-dimer > 500 ng/mL, or platelet count > 450,000 cells/µL, or a maxim clot lysis at viscoelastic test < 2%. A procoagulant state was identified in 75% of the patients at 3 months follow up, 50% at 6 months, and 30% at 12–18 months. Factors associated with the persistence of a procoagulant state were age, severity of the acute phase, and persistence of symptoms. Patients with major physical symptoms carry a procoagulant state relative risk of 2.8 (95% confidence interval 1.17–6.7, p = 0.019). The association between persistent symptoms and a procoagulant state raises the hypothesis that an ongoing process of thrombi formation and/or persistent microthrombosis may be responsible for the main physical symptoms in long-COVID patients.

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Section: Discussionmentioning

confidence: 99%

The Long Term Residual Effects of COVID-Associated Coagulopathy

Ranucci

Baryshnikova

Anguissola

et al. 2023

IJMS

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“…The second explanation, which is the prevalent one, focuses on microvascular in situ immunological thrombosis due to activation of the innate immune system. [8] Our patient, however, was not a known diabetic. He had been home quarantined when COVID positive without any hypoxia and received no corticosteroids during this period.…”

Section: Discussionmentioning

confidence: 62%

Post-COVID Pulmonary Aspergillosis with Pulmonary Thromboembolism and Pulmonary Artery Hypertension Unmasking Prediabetes: A Case Report

Kamath

Mishra

Munje

et al. 2023

VJIM

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Multiple complications during and following COVID-19 infection are being reported worldwide. The most serious and life-threatening are thromboembolism and invasive fungal diseases. We report a post-COVID-19 case with complications of fungal infection of the lungs and pulmonary thromboembolism with pulmonary hypertension and unmasking prediabetes. A 53-year-old male patient presented with complaints of cough, fever, exertional breathlessness for 15 days, chest pain and hoarseness of voice for 7 days. He had a prior history of COVID 10 months earlier and no comorbidities. On further investigation by computed pulmonary tomography angiography, bronchoscopy and other investigations, the patient was found to have pulmonary thromboembolism, pulmonary aspergillosis and pulmonary artery hypertension. He was treated with amphotericin B for 21 days and anticoagulants for 6 months. He had significant clinical and radiological improvement with the resolution of the embolism. The crucial factors for successful care in post-COVID-19 immune-suppressed patients include a high index of suspicion, early use of adequate diagnostic tests helped by antifungal medications, anticoagulants and control of risk factors such as hyperglycaemia.

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“…For instance, in a study in which 52 cases followed up in different centers were evaluated, the time from diagnosis to the time of PTE after COVID-19 infection was found to be in a wide range (7-180 days) with a mean of 35.1 days, and it was observed to be within the rst month following infection in the majority of cases. At the same time, most patients did not receive anticoagulant treatment because of mild disease at the time of infection [17]. In the study by Katsoularis et al using Swedish records, more than 1 million people with positive SARSCoV-2 test were matched according to age, sex, and county of residence and compared with a control group of more than 4 million people with negative SARSCoV-2 test.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Frequency of Previous Coronavirus Disease-19 as a Predisposing Factor in Pulmonary Thromboembolism and its Effect on Embolism Severity: A Multicenter, Observational, Cross-Sectional Study

Koçak,

Tutar,

Çil

et al. 2024

Preprint

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Background Knowledge of predisposing factors in developing pulmonary thromboembolism (PTE) is important in the diagnosis and treatment approach. The association between past coronavirus disease-19 (COVID-19) infection and PTE is a potential research topic. In this study we aimed to determine the prevalence of previous COVID-19 in addition to all predisposing factors for PTE development and to determine whether there is a difference in embolism severity in these cases. Methods Study design: Multicenter, observational, cross-sectional.Patients diagnosed with PTE between March 11, 2022, and March 11, 2023, were prospectively included in the study. Group 1: PTE cases with previous COVID-19, Group 2: PTE cases without previous COVID-19.To compare the categorical variables between groups the chi-square test was used.For continuous variables, parametric and non-parametric tests were used.Multivariate binary logistic regression analysis was performed to determine the independent variables related to PTE severity that affected the presence of previous COVID-19. Results Forty-four researchers from 33 centers participated in our study.A total of 1185 patients were included (Group 1; n = 360, Group 2; n = 825). The median post-COVID duration was 120.0 (min-max: 30–980) days. Computed tomography pulmonary angiography (CTPA) right ventricle/left ventricle (RV/LV) ratio > 1 was significantly higher in Group 2 compared to Group 1 (27.9% vs 19.7%, p = 0.003).The proportion of patients receiving systemic thrombolytic drugs (11.3% vs. 7.5%, p = 0.048), and the rate of patients who started treatment in the intensive care unit was higher in Group 2 (23.4% vs. 14.7%, p = 0.001).In multivariate logistic regression analysis, the absence of any identifiable risk factor for PTE was found to be a 0.46-fold protective factor in the presence of previous COVID-19 (95% CI: 0.274–0.760, p = 0.003) and an RV/LV ratio > 1 on CTPA was found to be a 0.60-fold protective factor (95% CI: 0.365–0.998, p = 0.049). Conclusions The prevalence of previous COVID-19 infection in PTE cases was 30.4%, and 26% of idiopathic cases had previous COVID-19 infection.Although the parameters related to embolism severity were higher in the non-COVID-19 group, in multivariate analyses, only idiopathic status was associated with a 2.2-fold increased risk in non-COVID-19 patients compared to those who had, and an RV/LV ratio > 1 on CTPA was associated with a 1.7-fold increased risk.

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Pulmonary Embolism in Post-CoviD-19 Patients, a Literature Review: Red Flag for Increased Awareness?

Cited by 18 publications

References 69 publications

The Long Term Residual Effects of COVID-Associated Coagulopathy

The Long Term Residual Effects of COVID-Associated Coagulopathy

Post-COVID Pulmonary Aspergillosis with Pulmonary Thromboembolism and Pulmonary Artery Hypertension Unmasking Prediabetes: A Case Report

Evaluation of the Frequency of Previous Coronavirus Disease-19 as a Predisposing Factor in Pulmonary Thromboembolism and its Effect on Embolism Severity: A Multicenter, Observational, Cross-Sectional Study

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