Pulmonary thromboembolic disease in COVID-19 patients on CT pulmonary angiography – Prevalence, pattern of disease and relationship to D-dimer

Ooi, Michelle Wei Xin; Rajai, Azita; Patel, R.; Gerova, N.; Godhamgaonkar, V.; Liong, Sue

doi:10.1016/j.ejrad.2020.109336

Cited by 63 publications

(74 citation statements)

References 24 publications

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“… 28 , 29 Imaging studies have confirmed that the radiological appearance of PE differs in COVID-19 compared with non–COVID-19 patients, with more peripheral localization of thrombi and generally lower clot burden. 30 , 31 These observations may support the hypothesis that for patients with COVID-19, PE may result from in situ immunothrombosis rather than from embolization from lower-extremity DVT. In this report, the term PE is used to collectively refer to both embolus and in situ thrombus of the pulmonary arteries.…”

Section: Introductionsupporting

confidence: 56%

American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19

et al. 2021

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Background: Coronavirus disease 2019 (COVID-19)–related critical illness and acute illness are associated with a risk of venous thromboembolism (VTE). Objective: These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in decisions about the use of anticoagulation for thromboprophylaxis for patients with COVID-19–related critical illness and acute illness who do not have confirmed or suspected VTE. Methods: ASH formed a multidisciplinary guideline panel and applied strict management strategies to minimize potential bias from conflicts of interest. The panel included 3 patient representatives. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic evidence reviews (up to 19 August 2020). The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE Evidence-to-Decision frameworks, to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 2 recommendations. The panel issued conditional recommendations in favor of prophylactic-intensity anticoagulation over intermediate-intensity or therapeutic-intensity anticoagulation for patients with COVID-19–related critical illness or acute illness who do not have confirmed or suspected VTE. Conclusions: These recommendations were based on very low certainty in the evidence, underscoring the need for high-quality, randomized controlled trials comparing different intensities of anticoagulation. They will be updated using a living recommendation approach as new evidence becomes available.

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Section: Introductionsupporting

confidence: 56%

American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19

et al. 2021

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“…The reported frequency of pulmonary embolism in critically ill COVID-19 patients is approximately 20%-30%[ 6 , 7 ]. Evidence suggests that small vessel pulmonary thrombi are more common than large pulmonary vessel involve-ment in COVID-19[ 8 , 9 ]. Pulmonary embolism is a serious thrombotic complication of COVID-19 pneumonia, with mortality rates for patients with COVID-19 and PE estimated at approximately 45%[ 10 ].…”

Section: What Is the Risk Of Vte In Covid-19?mentioning

confidence: 99%

COVID-19 and venous thromboembolism: Known and unknown for imaging decisions

Patel

Gandhi

Westergard

et al. 2021

WJR

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As we continue to fight against the current coronavirus disease-2019 (COVID-19) pandemic, healthcare professionals across the globe are trying to answer questions surrounding how to best help patients with the up-to-date available science while awaiting the development of new therapies and mass vaccination. Since early in the pandemic, studies indicated a heightened risk of venous thromboembolism (VTE) in COVID-19 infected patients. There have been differing expert opinions about how to assess pretest probability of VTE in this patient population. This has been partly due to the high prevalence of respiratory failure in this patient population and the use of D-dimer as a prognostic test which is also frequently elevated in patients with COVID-19 in absence of VTE. Some experts have argued for an approach similar to usual care with testing if clinical suspicion is high enough. Some have argued for more routine screening at different points of care. Others have even suggested empiric therapeutic anti-coagulation in moderate to severely ill COVID-19 patients. In the following article, we review and summarize the most current literature in hopes of assisting clinicians in decision making and guidance for when to be concerned for VTE in COVID-19 patients. We also discuss research gaps and share pathways currently being used within our institution.

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“…[44,45] Both fibrinogen levels and D-dimer levels have been shown to be elevated in COVID-19 patients, especially in severe cases who develop thromboembolic complications, and who only respond to higher doses of antithrombotic treatment. [9,21– 23,28,29,46,47] Additionally, heparin resistance has been reported in COVID-19 patients. [48,49] and could therefore explain the failure of anti-thrombotic therapies in some patients in reducing coagulopathy.…”

Section: Discussionmentioning

confidence: 99%

Role of Combining Anticoagulant and Antiplatelet Agents in COVID-19 Treatment: A Rapid Review

Matli

Farah

Maalouf

et al. 2021

Preprint

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Although primarily affecting the respiratory system, COVID-19 causes multiple organ damage. One of its grave consequences is a prothrombotic state that manifests as thrombotic, microthrombotic, and thromboembolic events.Therefore, understanding the effect of antiplatelet and anticoagulation therapy in the context of COVID-19 treatment is important. The aim of this rapid review is to highlight the role of thrombosis in COVID-19 and provide new insights on the use of antithrombotic therapy in its management. A rapid systematic review was performed using preferred reporting items for systematic reviews. Papers published in English on antithrombotic agent use and COVID-19 complications were eligible. Results showed that the use of anticoagulants increased survival and reduced thromboembolic events in patients. However, despite the use of anticoagulants, patients still suffered thrombotic events likely due to heparin resistance. Data on antiplatelet use in combination with anticoagulants in the setting of COVID-19 is quite scarce. Current side effects of anticoagulation therapy emphasize the need to update treatment guidelines. In this rapid review, we address a possible modulatory role of antiplatelet and anticoagulant combination against COVID‐19 pathogenesis. This combination may be an effective form of adjuvant therapy against COVID‐19 infection. However, further studies are needed to elucidate potential risks and benefits associated with this combination.

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Pulmonary thromboembolic disease in COVID-19 patients on CT pulmonary angiography – Prevalence, pattern of disease and relationship to D-dimer

Cited by 63 publications

References 24 publications

American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19

American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19

COVID-19 and venous thromboembolism: Known and unknown for imaging decisions

Role of Combining Anticoagulant and Antiplatelet Agents in COVID-19 Treatment: A Rapid Review

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