Abstract 13313: Venous Thromboembolism as a Presenting Finding and Complication of Covid-19: A Case Series

Abstract

Background: Although not yet fully understood, the pathogenesis of the novel RNA betacoronavirus2 currently named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is thought to involve thrombotic microangiopathy, as evidenced by autopsy. To date, the number of pulmonary embolism (PE) reports in the setting of COVID-19 is increasing, with many presenting in acute cor pulmonale. In this case series, we aim to describe our center’s experience with COVID-19 and PE. Methods: A total of 10 patients with a diagnosis of PE in the setting of positive qualitative SARS-CoV-2 through RT-PCR were identified and managed by our service. Results: The mean age was 58 years old with 60% being males. The majority of the population was Hispanic (70%) with 30% self-identifying as black. All of our patients were middle-aged except for one elder and one young adult, and they had other risk factors for thromboembolism, (e.g. obesity, heart failure, COPD, and HIV). The mean time from presentation to diagnosis of PE was 100 hours. Hemodynamic instability was present in 30% of the cases. There was a whole spectrum of PE involvement, the vast majority of which were segmental and subsegmental (60%) compared to distal main arteries (20%) and saddle PE (20%). Mortality rate was 10% and the rest of the patients were successfully discharged on oral anticoagulation. Although our cohort comprised low-to-intermediate pretest probability for PE per Wells criteria (1.5-3), high clinical suspicion prompted further imaging studies with computed tomography angiography and 2D-echocardiogram. Currently, many hospital systems are avoiding advanced imaging for concerns of infection control, which likely contributes to the underdiagnosis of VTE in patients with COVID-19. Conclusion: As we continue to understand the pathophysiology of this emerging disease, clinicians should maintain a high degree of suspicion to differentiate causes of hypoxemic respiratory failure and hemodynamic instability in the setting of COVID-19. Overt PE may increase inpatient mortality and post-discharge mobility due to the burden of pulmonary hypertension in this population. Further research is required to elucidate the relationship between these entities and the best management approach.