Pulmonary Embolism or Pulmonary Thrombosis in COVID-19? Is the Recommendation to Use High-Dose Heparin for Thromboprophylaxis Justified?

Low Detection Rate of Pulmonary Embolism in Patients Presenting to the Emergency Department With Suspected Coronavirus Disease 2019 (COVID-19): A Single-Centre UK Study

“…The findings of our study contrast with much of the published literature, as numerous published studies ( 1 , 2 , 3 , 4 , 12 , 18 , 19 ) report high prevalence of PE in patients with COVID-19 undergoing CTPA. The high prevalence of PE has prompted some groups to suggest consideration of including CT pulmonary angiography to chest CT examinations in patients with suspected COVID-19, as we have done at our institution ( 20 ).…”

“…Of interest, Cattaneo et al . report a low incidence of deep vein thrombosis (DVT) in their cohort and postulate that some of the findings on CTPA may relate to thrombosis in ITU patients rather than pulmonary embolus, given that PE often coexists with DVT ( 19 ). The low rate of PE observed in our study early in patient management correlates with the findings of their study and it has been suggested that PE later on in the disease may relate to pulmonary arterial thrombosis.…”

Fibrinolysis Resistance: A Potential Mechanism Underlying COVID-19 Coagulopathy

“…We read with great interest the article by Spiezia et al, published in a recent issue of the journal, showing a severe hypercoagulability on thromboelastometry profiles of 22 critically ill patients with novel coronavirus (SARS-CoV-2). 1 These results are in agreement with a growing body of evidence suggesting that COVID-19 severe infection predisposes to venous thromboembolism and even primary pulmonary thrombosis, 2 and that abnormal coagulation parameters are associated with poor prognosis. 3 The thrombotic risks in COVID-19 are such that consensus guidance has been issued for thromboprophylaxis, [3][4][5] leading to a large prescription of high doses of low molecular weight (LMWH) or unfractionated heparin, notwithstanding the need for more evidence.…”

Acute pulmonary embolism in acutely ill COVID-19 patients admitted to internal medicine wards.

“…However, empirical use of anticoagulant doses of heparin may not only be ineffective but deleterious since it has been well established that high-dose LMWH administration may be associated with increased incidence of major and fatal bleeding [26]. In fact, pending the results of randomized clinical trials, in patients without a con rmed diagnosis of APE, most authors recommend thromboprophylaxis with LMWH for non-ICU COVID-19 patients [5,27].…”