Incidence Of Pulmonary Thromboembolism Research Articles

Incidence of fatal and non-fatal pulmonary thromboembolism after removal of tunnelled central venous haemodialysis catheters without ultrasound scan and anticoagulation.

Catheter related thrombosis is a common complication of tunnelled central venous catheter (TCVC) usage. There are concerns that TCVC removal could dislodge a thrombus to cause pulmonary thromboembolism (PE). The incidence of PE following TCVC removal is unclear and so the aim of this study was to investigate the incidence of PE and whether it is high enough to warrant screening with ultrasound with a view to systemic anticoagulation prior to TCVC removal. 1102 consecutive TCVC removals without ultrasound and systemic anticoagulation were included in this retrospective study. Data were extracted from electronic health records. Measures to identify PE events included: deaths, computed tomography pulmonary angiogram (CT-PA), isotope lung perfusion scans and D-dimers blood tests within 7 days of removal. Of the 1102 TCVC removals, the mean age of patients was 56.9 years and 57.3% were male. The primary renal diagnosis for 24.5% of patients was diabetic nephropathy. There were seven deaths following removal, none of which had PE as a contributing cause on review of their clinical history and death certificates. Five CT-PAs and one isotope lung perfusion scan were carried out in the 7 days after TCVC removal and none had a positive finding of PE. Three patient had D-dimers measured in blood within 7 days and none of these patients were subsequently diagnosed with PE. There was no evidence of fatal or non-fatal PE's occurring in the 7 days following TCVC removal. This would support the practice of removing TCVCs without the need for ultrasound screening and without a period of systemic anticoagulation.

Incidence of pulmonary thromboembolism in patients who underwent CT pulmonary angiography in the first quarter of 2023 at CHC Rijeka

Cilj: Plućna tromboembolija (PTE) je hitno medicinsko stanje kod kojeg dolazi do okluzije jedne ili više grana plućnih arterija tromboembolusom. CT plućna angiografija (CTPA) je brza, neinvazivna radiološka metoda kojom se postavlja dijagnoza PTE. Glavni cilj ovog rada je odrediti incidenciju pozitivnih PTE nalaza kod 524 pacijenta podvrgnutih CTPA te odrediti učestalost zahvaćenih grana plućnih arterija. Nadalje, jedan od ciljeva je i odrediti incidenciju usputnih nalaza (plućni nodusi, tumor pluća, pneumonija, infarkt pluća, pleuralni izljev). Ispitanici i metode: U ovom retrospektivnom istraživanju prikupljeni su podaci 524 bolesnika koji su zbog sumnje na PTE podvrgnuti CTPA pregledu na Kliničkom zavodu za dijagnostičku i intervencijsku radiologiju, na lokalitetu Sušak, u Kliničkom bolničkom centru (KBC) Rijeka, u razdoblju od siječnja do travnja 2023. godine. Svi potrebni podaci navedeni u nalazu radiologa prikupljeni su iz integriranog bolničkog informacijskog sustava (IBIS) i pripadajuće aplikacije (ISSA). Rezultati: Od ukupno 524 bolesnika podvrgnutih CTPA, PTE je dokazana kod 97 ili 18,51% pacijenata. U našem istraživanju bio je podjednak broj ispitanika muškog i ženskog spola (260 ili 49,62% naprema 264 ili 50,39%). Nešto je veća incidencija PTE bila kod muškaraca (52 ili 53,61%) nego kod žena (45 ili 46,39%). Najveći broj bolesnika (262 ili 50,00%) pripadao je dobnom razredu između 61. i 80. godine života. Usputni nalazi opisani na CTPA, prema redoslijedu učestalosti su bili: pneumonije (37,15%), pleuralni izljevi (34,86%), plućni nodusi (16,79%), tumori pluća (6,87%) i plućni infarkti (4,33%). Zaključak: CT plućna angiografija predstavlja zlatni standard za detekciju plućne tromboembolije. Pregledom dostupne literature, incidencija PTE je komparabilna s rezultatima našeg istraživanja. U našoj, kao i u većini recentnih studija, PTE je najčešće detektirana u segmentalnim i subsegmentalnim granama plućnih arterija, dok se incidencija usputnih nalaza detektiranih na CTPA ne podudara s rezultatima drugih istraživanja.

INCIDENCE OF PULMONARY THROMBOEMBOLISM IN PATIENTS WITH COVID-19 ADMITTED TO THE INTENSIVE CARE CENTER

Introduction: Sars-CoV-2 imposed complex challenges on the global community, on March 11, 2020, when the World Health Organization (WHO) declared COVID-19 as a pandemic, it aroused concern from public and private health institutions internationally, due to to the high proportions of dissemination and risk to global health. Objective: to investigate the incidence of pulmonary thromboembolism (PT) in patients hospitalized for COVID-19 in an Intensive Care Unit (ICU) in southern Brazil. Method: documentary and descriptive research, quantitative approach, through a retrospective analysis of the medical records of patients treated at the ICU. Results: data collection resulted in 306 medical records of patients admitted to the ICU, 64.7% were positive for COVID-19, comprising the sample of interest for the present study, 59% men and 41% women, mean age 53, 8 ± 13.3 years, the constantly cited comorbidities were hypertension, diabetes mellitus and obesity. The sample showed an incidence of PT of 11% in the ICU, the PT+ group had a longer hospital stay compared to the COVID-19 group, angiotomography was performed 7.3 ± 6.3 days after the presence of symptoms compatible with PT, the morbidity and mortality was similar between groups. In the PT+ group, the length of stay and the presence of hypertension were greater than in the COVID-19 group. Conclusion: the understanding that COVID-19 is a respiratory disease, but that through its aggravation, it can evolve into a complication in the coagulative system, predisposing to thrombotic events, is essential, especially to recognize PT early, thus allowing greater chance in the treatment and early diagnosis of this disease.

Effects of Deep Venous Thrombosis Treatments on Early and Long-term Quality of Life: Medical Therapy vs. Systemic Thrombolysis vs. Pharmacomechanical Thrombolysis.

The present study aimed to compare the effects of medical therapy (MT), systemic thrombolysis (ST), and pharmacomechanical thrombolysis (PMT) methods used in our clinic for the treatment of deep venous thrombosis (DVT) on symptom reduction, the incidence of post-thrombotic syndrome (PTS) development, and quality of life. Data from160 patients diagnosed with acute DVT between January 2012 and May 2021 and treated and followed up in our clinic were retrospectively analyzed. The patients were divided into three groups according to treatment method. The patients who received MT treatment were defined as Group 1, anticoagulant treatment after ST as Group 2, and anticoagulant treatment after PMT as Group 3. The patients were called to the outpatient clinic, informed consent was obtained, EuroQol-5D-3L (EQ-5D-3L) scoring and Villalta scoring were performed, and anamnesis was taken. A total of 160 patients were included, with 71 (44.4%) patients in Group 1, 45 (28.1%) in Group 2, and 44 (27.5%) in Group 3. The mean age was 48.9 ± 14.9years for Group 1, 42.2 ± 10.8 for Group 2, and 29.0 ± 7.2 for Group 3. When the time to return to normal life and the EQ-5D-3L score index were compared, the differences between Groups 1 and 2 and between Groups 1 and 3 were statistically significant (P = .000 and P = .000, respectively). However, the differences between Groups 2 and 3 were statistically insignificant (P = .213 andp = .074, respectively). When Villalta scores and EQ Visual Analogue Scale (EQ-VAS) scores were compared between groups, the difference between all groups was statistically significant (P = .000). The medical treatment alone was observed to be insufficient in terms of symptomatic improvement, development of PTS, quality of life, and long-term complications. When the ST and PMT groups were compared, it was determined that PMT treatment was more advantageous in terms of EQ-VAS score and PTS development, although there was no statistical difference regarding complications, such as return to normal life and long-term quality of life, the incidence of recurrent DVT development, and pulmonary thromboembolism incidence.

BHMT polymorphism and susceptibility to PTE in Chinese patients.

Pulmonary thromboembolism (PTE) is as a common form of venous thrombosis and a potentially fatal cardiovascular disorder, which has become a severe clinical problem with high incidence and mortality. The PTE has a strong genetic basis, which contributes up to half of the variance in PTE incidence and susceptibility single-nucleotide polymorphisms (SNPs) is associated with PTE. Betaine homocysteine methyltransferase (BHMT) is an essential enzyme that catalyzes the remethylating reaction from homocysteine to methionine and participates in conserving methionine and detoxifying homocysteine. In this work, we aimed to explore BHMT polymorphism and susceptibility to PTE in Chinese patients. Variant loci of the BHMT gene were screened in serum samples of PTE patients, followed by verification using Sanger sequencing. These polymorphic loci were validated in 16 PTE patients and 16 matched normal patients. The frequency differences between the allele and genotypes were compared using the Hardy-Weinberg equilibrium test and Chi-square test. A SNP was identified in PTE patients and a heterozygous transition of G>A (Arg239Gln) in rs3733890 was found. The variance difference at rs3733890 between normal patients (2/16, 0.125) and PTE patients (9/16, 0.5625) was significant (p<0.01). Therefore, we concluded that the BHMT polymorphism, rs3733890 may be a susceptibility SNP for PTE.

Incidence and risk factors of venous thrombotic events in patients with interstitial lung disease during hospitalization

BackgroundStudies on the incidence of venous thromboembolism (VTE) events in patients with interstitial lung disease (ILD) are limited and the results are inconsistent. The aim of this research was to investigate the incidence and risk factors of VTE in ILD during hospitalization.Materials and methodsIn this retrospective, cross-sectional, observational study, a total of 5009 patients diagnosed with ILD from January 2016 to March 2022 in our hospital were retrospectively included. In ILD patients, VTE including pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT) were screened from the electronic medical record system. Diagnosis of PTE and DVT were performed by CT pulmonary angiography (CTPA), CTV or ultrasound. And then the incidence and risk factors of VTE in different types of ILD were assessed.ResultsAmong 5009 patients with ILD, VTE was detected in 129 (2.6%) patients, including 15(0.3%) patients with both PTE and DVT, 34 (0.7%) patients with PTE and 80 (1.6%) patients with DVT. 85.1% of patients with APE were in the intermediate-low risk group. The incidence of VTE in Anti-Neutrophil Cytoplasmic Antibodies -associated vasculitis related ILD (ANCA-AV-ILD), hypersensitivity pneumonitis and idiopathic pulmonary fibrosis (IPF) respectively was 7.9% and 3.6% and 3.5%. In patients with connective tissue disease-associated ILD (CTD-ILD), the incidence of VTE, DVT, PTE, combined PTE and DVT respectively was 3.0%, 2.3%, 0.4% and 0.3%. Among the various risk factors, different ILD categories, age ≥ 80 years (OR 4.178, 95% CI 2.097–8.321, P < 0.001), respiratory failure (OR 2.382, 95% CI 1.533–3.702, P < 0.001) and varicose veins (OR 3.718, 95% CI 1.066–12.964, P = 0.039) were independent risk factors of VTE. The incidence of VTE in patients with ILD increased with the length of time in hospital from 2.2% (< 7 days) to 6.4% (> 21 days).ConclusionThe incidence of VTE during hospitalization in ILD patients was 2.6%, with a 1.6% incidence of DVT, higher than the 0.7% incidence of PTE. Advanced age, ILD categories, respiratory failure and varicose veins as independent risk factors for the development of VTE should be closely monitored.

Pulmonary Thromboembolism Developed During Hospitalization: A Nationwide Retrospective Observational Study Using Claims Data.

Evidence regarding the development of pulmonary thromboembolism (PE) during hospitalization is unclear. We hypothesized that the incidence of PE could vary depending on clinical department and aimed to conduct a survey on the incidence of in-hospital PE. We conducted a retrospective analysis using claims data of in-hospital patients in Japan. We collected background information regarding patients with and without PE occurrence during hospitalization. Further, we determined the incidence of PE and implemented prophylactic procedures in patients with and without surgery according to clinical department at admission. Finally, we examined the duration of hospital stay and in-hospital mortality rates in patients with and without PE. We found that 5007 (0.107%, 20.61 per 1000 person-years) patients developed PE during hospitalization and differed by clinical department at admission. Moreover, 2272 (0.095%, 19.3 per 1000 person-years) and 2735 (0.119%, 21.8 per 1000 person-years) patients with and without surgery, respectively, developed PE during hospitalization (P < 0.001). Further, 33.8% of inpatients underwent prophylactic procedures for PE; however, the implementation rate differed between patients with and without surgery (59.2% vs. 7.3%, P < 0.001). The median duration of hospital stay in patients with and without PE was 31.0 and 11.0days, and the in-hospital mortality rates in patients with and without PE were 11.0% and 3.5%, respectively (P < 0.001). The incidence of in-hospital PE differed according to patient characteristics, clinical departments, and presence/absence of surgery. The onset of PE during hospitalization leads to prolonged hospital stay and in-hospital death. It is important to conduct a proper risk assessment on admission as well as to implement proper prophylactic procedures to prevent the development of PE during hospitalization.

High incidence of pulmonary thromboembolism in hospitalized SARS-CoV-2 infected patients despite thrombo-prophylaxis

BackgroundSARS-CoV-2 infected patients present thrombotic complications caused by direct endothelial cells injury of the microvessels. Pulmonary thromboembolism (PE) has been reported by Computed Tomography pulmonary angiogram (CTPA) in patients with COVID-19 pneumonia with high D-dimer levels. ObjectivesWe present the characteristics of SARS-CoV-2 infected patients diagnosed of PE by CTPA in our hospital. We also present the comparison of these findings with non-infected patients with PE data. MethodsRetrospective observational cohort study that included patients over 18 years of age hospitalised consecutively between 26th February and 20th May 2020 in an European Hospital with SARS-CoV2 virus infection, and with suspected infection at beginning of admission but with negative PCR, who were studied with CTPA for suspicion of VTE, during their hospitalization. ResultsDuring the study period, 52 CTPA were performed in our hospital, sixteen in SARS-CoV-2 infected patients, with 4 cases (33%) of PE in the infected group, and 11 (44%) in the non-infected group. No significant differences in age (p = 0.43) and sex (p = 0.31) were found between the two groups, infected and non-infected patients. In the infected group, the patients who had PE had a much lower median age (47.8 years) than those without PE (73.3 years). No differences between infected and non-infected patients were detected in the diagnosis of PE with CTPA, 28.6% versus 27.8% (p = 1.00). Overall patient mortality was 1.9%; one patient died (6.3%) in the infected group, and none in the non-infected group (p = 0.31). ConclusionA considerable incidence of PE diagnosed by CTPA in SARS-CoV-2 infected patients has been observed, despite thrombo-prophylaxis.

Chest radiological finding of COVID-19 in patients with and without diabetes mellitus: Differences in imaging finding.

The pandemic of novel coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Diabetes mellitus is a risk factor for developing severe illness and a leading cause of death in patients with COVID-19. Diabetes can precipitate hyperglycaemic emergencies and cause prolonged hospital admissions. Insulin resistance is thought to cause endothelial dysfunction, alveolar capillary micro-angiopathy and interstitial lung fibrosis through pro-inflammatory pathways. Autopsy studies have also demonstrated the presence of microvascular thrombi in affected sections of lung, which may be associated with diabetes. Chest imaging using x-ray (CXR) and computed tomography (CT) of chest is used to diagnose, assess disease progression and severity in COVID-19. This article reviews current literature regarding chest imaging findings in patients with diabetes affected by COVID-19. A literature search was performed on PubMed. Patients with diabetes infected with SARS-CoV-2 are likely to have more severe infective changes on CXR and CT chest imaging. Severity of airspace consolidation on CXR is associated with higher mortality, particularly in the presence of co-morbidities such as ischaemic heart disease. Poorly controlled diabetes is associated with more severe acute lung injury on CT. However, no association has been identified between poorly-controlled diabetes and the incidence of pulmonary thromboembolism in patients with COVID-19.

Childhood-onset enthesitis-related arthritis leading to nephrotic syndrome due to secondary amyloidosis complicated by acute pulmonary embolism - The domino effect

The prevalence of Juvenile idiopathic arthritis (JIA) in India is 0.001% among the population under 16 years old and 0.00029% among the total population. Of the total JIA population, enthesitis-related arthritis (ERA) constitutes 35% of the cases. In the past, chronic infections, mainly, tuberculosis were the most common cause of AA amyloidosis in India; however, chronic inflammatory arthropathies have become the most common cause of AA amyloidosis in India over the past three to four decades. In 95% of the patients with AA amyloidosis, the kidney is the most affected organ presenting as proteinuria of nephrotic syndrome. The prevalence of AA amyloidosis in JIA is estimated to be 7.7% and 3.1% among the ERA group, making it an infrequent association. This translates to one case of AA amyloidosis secondary to ERA per 1,00,000,00 population in India. Similarly, the incidence of pulmonary thromboembolism in patients with nephrotic syndrome is 7.8%. We present a case of a young male who was diagnosed with JIA-ERA at the age of 13 years with multiple flares in childhood had now developed nephrotic syndrome secondary to AA amyloidosis demonstrated on renal biopsy complicated by acute pulmonary embolism and occult hepatitis B infection. He was managed with anti-tumor necrosis factor inhibitor therapy with a favorable outcome. This is the first such case of multiple rare associations occurring together in a single patient to the best of our knowledge.

Prophylaxis and treatment of pulmonary thromboembolism in COVID-19 patients

In 2019, a completely unique pneumonia, called coronavirus disease 2019 (COVID-19), spread rapidly throughout the planet. This novel global pandemic severely threatened public respiratory health and medical services. To date, apart from the common respiratory symptoms, coagulation disorders, especially Pulmonary Thromboembolism (PTE), has been proven as a crucial complication in severe COVID-19 patients, and therefore the incidence of PTE causes poor clinical outcome and increased fatality. Therefore, it’s important that healthcare providers, including respiratory physicians, medicine specialists, hematologists, cardiologists, communicable disease specialists, and other specialists, recognize that patients with COVID-19 are at increased risk of PTE, and make sure that appropriate prophylaxis is run to the acceptable patients, which they effectively manage PTE when it does occur. The mechanism of PTE in patients with coronavirus pneumonia consists of endothelial injury, activated platelet, cytokine storm, and a suppressed fibrinolytic system. Early prophylaxis, antiviral therapy, anticoagulation, and supportive treatment are beneficial to COVID-19 patients. In this review, we summarize the harm that coronavirus pneumonia wreaks and highlight the clinical relationship between PTE and coronavirus infection. The potential mechanism and therefore the prophylaxis and therapeutic measures also are discussed to involve more effort and research to research the strategies for PTE in COVID-19.

Analysis of CRP, Antithrombin, Fibrinogen, and Hematological Changes in 433 Patients with PTE.

ObjectiveTo investigate the characteristics of coagulation indicators, such as C-reactive protein (CRP), antithrombin (AT), and fibrinogen (FB) in patients with pulmonary thromboembolism (PTE) and their relationship with PTE.MethodsThe clinical characteristics, CRP, AT, FB, plasma D-dimer (D-D) and platelet (PLT) counts, and blood coagulation indicators of 433 patients with PTE diagnosed by computed tomographic pulmonary angiography (CTPA) were comprehensively analyzed, and the relevant clinical significance was discussed.ResultsThe total incidence of PTE was 1.60% (433/270,983 cases), and the age group with the highest incidence was over 60 years old. D-D increased in 412 (95.2%) patients. PLT was normal in 331 (76.4%) cases, but decreased in 53 (12.3%) cases and increased in 49 (11.3%) cases. CRP increased in 76.0% (288/379 cases) and was normal in 24.0% (91/379 cases). AT decreased in 109 (25.2%) cases and FB increased in 102 (23.6%) cases. There were no significant changes in other coagulation indexes. CRP was positively correlated with PLT and FB (r = 0.1026, t = 2.0118, P < 0.05, and r = 0.5360, t = 12.2963, P < 0.01, respectively). CRP was negatively correlated with AT (r = –0.2005, t = 4.0100, P < 0.01).ConclusionThe incidence of PTE was higher in hospitalized patients. Most patients with PTE have increased CRP and FB and decreased AT, and these levels may be related to the occurrence of PTE.

Pulmonary thromboembolism in hospitalised patients with COVID-19: a retrospective national study of patients managed in critical care and ward environments in Scotland

ObjectivesTo assess for increase in pulmonary thromboembolism (PTE) in hospitalised patients with COVID-19, in both critical care and ward environments.SettingWe reviewed all CT pulmonary angiograms (CTPA) performed in Scotland between...

Inhibitory effects of amniotic fluid on the activated protein C anticoagulation system in maternal plasma.

Pulmonary thromboembolism (PTE) is one of the leading causes of maternal mortality. We previously reported that possible contamination of amniotic fluid (AF) into maternal circulation accelerated thrombin production and activated platelet function in maternal blood through the extrinsic pathway, which may be associated with the high incidence of PTE in early puerperium. However, it remains unclear whether the maternal anticoagulation system, e.g., the activated protein C (APC) pathway, contributes to the hypercoagulable condition induced by AF. Our previous study using an endogenous thrombin potential (ETP)-based assay revealed that sensitivity to APC was reduced during the postpartum first day, i.e., immediately after delivery, when parturients were supposed to be exposed to AF. Our aim is to investigate the susceptibility of maternal plasma to APC when mixed with AF. We collected plasma from 51 pregnant females and mixed with AF as well as APC. APC-sensitivity ratio (APC-sr) was calculated using the ETP-based assay. Addition of AF to maternal plasma showed a significant increase of ETP in the presence of APC. APC-sr was significantly increased, indicating decreased sensitivity to APC, after AF mixture to maternal plasma. The present APC-sr difference with AF contamination was smaller than that we reported previously in venous thromboembolism cases. The inhibitory effects of AF on the APC anticoagulation pathway may contribute, at least partly, to further promotion of thrombin production induced by AF. Combined with other classical thrombophilic risk factors, the present findings support possible involvements of AF exposure in the high incidence of PTE in early puerperium.

Reliability and validity of D-dimer monitoring for pulmonary thromboembolism in patients with unresectable, advanced or recurrent colorectal cancer treated with bevacizumab.

Pulmonary thromboembolism (PTE) is one of the leading causes of death among cancer outpatients. The aim of the present study was to investigate the reliability and validity of D-dimer monitoring for PTE in patients with unresectable, advanced or recurrent colorectal cancer treated with bevacizumab. A total of 25 patients with advanced colorectal cancer who received bevacizumab combination chemotherapy as primary treatment were retrospectively reviewed. The selection criteria included that D-dimer tests were performed repetitively, and that chest and abdominal contrast-enhanced CT scans were completed. The D-dimer levels and the presence or absence of PTE on CT images were retrospectively examined. Four cases (16%) were detected as having asymptomatic PTE. The D-dimer values at the onset of PTE were 14.2, 4.6, 1.1 and 0.9 µg/ml. The negative predictive value was 90.5% when 3.0 µg/ml was set as the D-dimer level cutoff value. The incidence of PTE, including asymptomatic PTE, in the present study was higher compared with that reported in previous studies on various types of cancer, of various stages and treated with different chemotherapy regimens. In patients with bevacizumab-treated unresectable, advanced or recurrent colorectal cancer, the D-dimer test was found to be less useful for exclusion diagnosis; however, along with chest CT, it may be useful in the detection and diagnosis of PTE. However, the determination of the optimal reference values and appropriate measurement timing of D-dimer testing requires further study.

The incidence of pulmonary thromboembolism in COVID-19 patients admitted to the intensive care unit: a meta-analysis and meta-regression of observational studies

ObjectivesCoronavirus disease 2019 (COVID-19) infection is associated with a prothrombotic state. We performed a meta-analysis of proportions to estimate the weighted average incidence of pulmonary thromboembolism (PTE) in COVID-19 patients who were admitted to the intensive care unit (ICU).MethodsWe searched various medical databases for relevant studies from 31 December 2019 till 30 September 2020. We included observational studies that reported the incidence of PTE in COVID-19 patients admitted to the ICU. We extracted data related to study characteristics, patient demographics, and the incidence of PTE. Risk of bias was assessed by using the ROBINS-I tool. Statistical analysis was performed with R 3.6.3.ResultsWe included 14 studies with a total of 1182 patients in this study. Almost all patients in this meta-analysis received at least prophylactic anticoagulation. The weighted average incidence of PTE was 11.1% (95% CI 7.7% to 15.7%, I2 = 78%, Cochran’s Q test P < 0.01). We performed univariate and multivariate meta-regression, which identified the proportion of males as a significant source of heterogeneity (P = 0.03, 95% CI 0.00 to − 0.09)ConclusionThe weighted average incidence of PTE remains high even after prophylactic anticoagulation. PTE is a significant complication of COVID-19 especially in critically ill patients in the ICU.

Pulmonary thromboembolism in coronavirus disease 2019 patients undergoing thromboprophylaxis.

We aimed to investigate the prevalence of pulmonary thromboembolism (PTE) and its association with clinical variables in a cohort of hospitalized coronavirus disease 2019 (COVID-19) patients receiving low-molecular-weight heparin (LMWH) at prophylactic dosage.In this retrospective observational study we included COVID-19 patients receiving prophylactic LMWH from admission but still referred for lower-limbs venous Doppler ultrasound (LL-US) and computed tomography pulmonary angiography (CTPA) for clinical PTE suspicion. A dedicated radiologist reviewed CTPA images to assess PTE presence/extension.From March 1 to April 30, 2020, 45 patients were included (34 men, median age 67 years, interquartile range [IQR] 60–76). Twenty-seven (60%) had PTE signs at CTPA, 17/27 (63%) with bilateral involvement, none with main branch PTE. In 33/45 patients (73%) patients LL-US was performed before CTPA, with 3 patients having superficial vein thrombosis (9%, none with CTPA-confirmed PTE) and 1 patient having deep vein thrombosis (3%, with CTPA-confirmed PTE). Thirty-three patients (73%) had at least one comorbidity, mainly hypertension (23/45, 51%) and cardiovascular disease (15/45, 33%). Before CTPA, 5 patients had high D-dimer (11.21 μg/mL, IQR 9.10–13.02), 19 high fibrinogen (550 mg/dL, IQR 476–590), 26 high interleukin-6 (79 pg/mL, IQR 31–282), and 11 high C-reactive protein (9.60 mg/dL, IQR 6.75–10.65), C-reactive protein being the only laboratory parameter significantly differing between patients with and without PTE (P = .002)High PTE incidence (60%) in COVID-19 hospitalized patients under prophylactic LMWH could substantiate further tailoring of anticoagulation therapy.

Cardiac Complications in Patients Infected with COVID-19

Abstract Cardiovascular disease remains the leading cause of death and morbidity worldwide. The appearance of the pandemic with COVID-19 at the beginning of this year all over the world makes the approach of the patients different. SARS-CoV-2 has major implications for the cardiovascular system. In addition to acute complications, COVID-19 infection can predispose to cardiovascular disease. Recent data show that myocarditis occurs in some patients with COVID-19, a few days after the onset of fever. This indicates the possibility of viral nature of myocardial lesions. In addition, patients infected with COVID-19 may be tachycardic (with or without palpitations) in relation to other symptoms related to the disease (fever, tachypnea, pain). They noticed several particular aspects, including rhythm disorders. It is known that in patients with pneumonia, hypercoagulability and systemic inflammatory activity may persist for a long time. This explains the occurrence of arterial and venous thrombotic complications in acute coronary syndromes or venous thromboembolism. The latest guideline for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic states that, although there is no solid evidence to date, the incidence of pulmonary thromboembolism in infected patients is high, thus recommending prophylactic doses of anticoagulant. The COVID-19 pandemic has affected millions of patients and poses an international health threat and considerable efforts are currently being made to evaluate new therapies to counteract this virus.

Relation of pulmonary thromboembolism and significance of laboratory parameters (d-dimer-fibrinogen) of patients with isolated COPD during exacerbation

Aim: Dyspnea can be a symptom of many diseases. Pulmonary thromboembolism (PTE) is the most important one of these conditions. It can occur together with COPD and PTE, and their symptoms may mask each other. Identify the relationship between d-dimer levels of patients diagnosed with COPD exacerbation; is to determine the cut-off value in case of connection. It is aimed to guide clinicians in their patient management according to the results. Materials and Methods: This study was conducted prospectively. Patient group was 49 patients presenting to the emergency department with exacerbation of COPD who have no comorbid disease such as malignancy, Diabetes Mellitus (DM), Chronic Hearth Failure (CHF); were over than 18 years old, non-pregnant; and with Glasgow Coma Scale (GCS) &amp;gt; 10 points and the control group consisted of 52 patients who presented to the emergency department with dyspnea who haven't got any diseases. Results: 65% of COPD patients are male. The most common comorbid disease was Hypertension (p &amp;lt;.05) in 7 patients (14,2%). Fibrinogen and d-dimer were higher in the patient group (p &amp;lt;.05). The D-dimer cut-off value in patients with COPD was 0.97 μg / ml (p&amp;lt;.05). Pulmonary thromboembolism was detected in 3 COPD attack patients (6%) (p &amp;lt;.05). During COPD exacerbation inflammatory markers such as C-reactive protein (CRP), D-dimer, fibrinogen increases. Conclusions: The incidence of PTE was significantly increased in patients with COPD exacerbation. PTE should be absolutely included in the differential diagnosis in patients presenting to the emergency department with dyspnea and necessary examinations should be performed for the retraction.

Coronavirus Pneumonia and Pulmonary Thromboembolism

Abstract In 2019, a novel pneumonia, called coronavirus disease 2019 (COVID-19), spread rapidly throughout the world. This novel global pandemic severely threatened public respiratory health and medical services. To date, except for the common respiratory symptoms, coagulation disorders, especially pulmonary thromboembolism (PTE), has been proven as an important complication in severe COVID-19 patients, and the incidence of PTE causes poor clinical outcome and increased fatality. Therefore, it is important that healthcare providers, including respiratory physicians, emergency medicine specialists, hematologists, cardiologists, infectious disease specialists, and other specialists, recognize that patients with COVID-19 are at increased risk of PTE, and ensure that appropriate prophylaxis is administered to the appropriate patients, and that they effectively manage PTE when it does occur. The mechanism of PTE in patients with coronavirus pneumonia consists of endothelial injury, activated platelet, cytokine storm, and a suppressed fibrinolytic system. Early prophylaxis, antiviral therapy, anticoagulation, and supportive treatment are beneficial to COVID-19 patients. In this review, we summarize the harm that coronavirus pneumonia wreaks and highlight the clinical relationship between PTE and coronavirus infection. The potential mechanism and the prophylaxis and therapeutic measures are also discussed to call for more effort and research to investigate the strategies for PTE in COVID-19.