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You have accessJournal of UrologyLetters to the Editor/Errata1 Oct 2020Reply by Authorsis a reply to letterRe: COVID-19 Coagulopathy: Considerations for Urologists J. S. Jue and M. Alameddine J. S. JueJ. S. Jue More articles by this author and M. AlameddineM. Alameddine More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001229AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail The COVID-19 pandemic has drawn attention toward respiratory symptoms and treatment of multiple organ dysfunction syndrome, while urological complaints and pathologies are sometimes overlooked. Cai et al describe a series of 18 patients with SARS-CoV-2 infection and superimposed urosepsis during the pandemic. In their series 5 of 18 patients (28%) were diagnosed with PE immediately after the onset of urosepsis. The authors note that 40% of the patients with PE died, while 60% were successfully treated. These initial results highlight the increased prevalence of thromboembolism in patients with COVID-19 with active urological problems. Cai et al do not mention if the PEs in their series were detected incidentally or as a result of a sudden change in clinical status. They also do not mention the specific venous thromboembolism (VTE) prophylaxis used prior to PE diagnosis. It is essential that patients with COVID-19 be treated with pharmacological VTE prophylaxis while inpatients, and escalated to therapeutic anticoagulation if a new VTE is confirmed.1 Initiation of therapeutic anticoagulation for suspected PE has been commonly practiced during the COVID-19 pandemic due to difficulty transporting mechanically ventilated patients for cross-sectional imaging and initiatives to limit staff exposure to COVID-19.1 Currently reasons to suspect PE include sudden respiratory decompensation, evidence of right heart strain and confirmation of deep vein thrombosis. There is likely low value in performing computerized tomographic pulmonary angiography purely in the setting of urosepsis without clinical suspicion of PE. It is important to remember that many patients with urosepsis or SARS-CoV-2 infection have a concomitant acute kidney injury (AKI). Patients with both infections are likely to have an AKI that is multifactorial in nature. AKI in COVID-19 has been attributed to cardiovascular comorbidities, endothelial damage, immune response dysregulation and microthromboemboli.2 AKI in the setting of COVID-19 progresses to the point of requiring renal replacement therapy in 2% to 9% of patients.3,4 This rate increases to 6% to 23% when severe infection is present.5,6 Therefore, we only recommend diagnostic testing for PE if clinically suspected, in order to avoid the unnecessary risks associated with therapeutic anticoagulation and intravenous contrast material. Reference 1. : COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020; 135: 2033. Google Scholar 2. : Management of acute kidney injury in patients with COVID-19. Lancet Respir Med 2020; doi: 10.1016/S2213-2600(20)30229-0. Crossref, Google Scholar 3. : Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507. Google Scholar 4. : Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323: 1061. Google Scholar 5. : Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8: 475. Google Scholar 6. : Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708. Google Scholar © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology1 Jul 2020Re: COVID-19 Coagulopathy: Considerations for Urologists Volume 204Issue 4October 2020Page: 849-850 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information J. S. Jue More articles by this author M. Alameddine More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...