key: cord-0935615-i7wf0c9w
authors: Miró, Òscar; Llorens, Pere; Aguirre, Alfons; Lozano, Laura; Beaune, Sebastien; Roussel, Mélanie; Le Borgne, Pierrick; Chouihed, Tahar; Freund, Yonathan
title: Association between Covid-19 and Pulmonary Embolism (AC-19-PE study)
date: 2020-09-10
journal: Thromb Res
DOI: 10.1016/j.thromres.2020.09.010
sha: 2dde409c66e4e7fe6bf0914d3f8d4ddfe556c6b4
doc_id: 935615
cord_uid: i7wf0c9w

• The frequency of PE in COVID patients attending Spanish and French ED is around 0.7%; • The risk of PE in patients coming to ED is more than 7-fold higher in COVID than in non-COVID population. • When PE is suspected and CTPA is ordered in the ED, the rate of final PE diagnosis is similar in COVID and non-COVID patients.

Infection by SARS-Cov-2 is mainly characterized by fever and respiratory symptoms, with dyspnea and lung infiltrates in more severe cases 1 . Many patients also present with a pro-coagulant state, characterized by increased D-dimer levels and associated with increased complications and a worse prognosis 1 . Accordingly, pulmonary embolism (PE) could be more frequent in patients with COVID-19. Single center caseseries reported a PE incidence of 2.6% (10/388) 2 and 8.2% (23/280) 3 in hospitalized patients and 20.6% (22/107) in patients admitted to intensive care 4 . As hospitalization itself is a risk factor for venous thromboembolism, it is not known if these PE incidences are part of the pathogenesis of SARS-Cov-2 or only occur because patients are bedridden, receiving multiple medications and in very poor condition. Focusing on patients with COVID at on arrival to the emergency department (ED), before hospitalization and the initiation of specific treatments for SARS-COV-2 infection, could help to answer this question 5, 6 . In the PEPCOV study, we found that among patients at high-risk of PE undergoing a computerized tomography pulmonary arteriography (CTPA) in the ED, PE was not more frequent in COVID compared to non-COVID patients, even after adjustment for differences among patients 7 . We designed AC-19-PE (Association between COVID-19 and Pulmonary Embolism) study to further explore this hypothesis by determining whether PE is more frequently suspected by emergency physicians and whether PE is more frequently diagnosed during the COVID pandemic and in COVID-affected patients. We calculated the raw odds ratio (OR) with the 95% confidence interval (95%CI) for PE suspicion (i.e., patients in whom a CTPA was ordered in the ED because of PE was suspected based on patient signs and symptoms) and diagnosis (i.e., patients in whom PE was radiologically detected in the CTPA) in the COVID versus the pre-COVID period, and in COVID versus non-COVID patients. The frequency of PE in COVID patients attending the ED is 6.64‰ (95%CI=5.06-8.56‰), which was more than 7-fold higher than that in the non-COVID ED population.

This relatively high rate suggests that during the COVID period, the ED population comprised more patients with suspected and diagnosed PE, due, in part, to a higher suspicion by emergency physicians and also to fewer ED visits for other complaints (due to lockdown measures). However, some study limitations impose caution in interpreting our findings. In many cases the diagnosis of COVID was based on clinical/radiological findings, with no microbiological confirmation. Further PE was only counted for study purposes if a CTPA was performed in the ED. During the COVID-19 pandemic, emergency physicians had a lower threshold for ordering CTPA (OR=2.39), although CTPA positivity for PE did not differ between periods (OR=1.04), confirming that SARS-COV-2 is not associated with a higher incidence of PE among high risk patients 7 . However, a higher proportion of ED patients were diagnosed with PE during the COVID period (OR=6.24) and among COVID patients (OR=7.24) when all ED comers (and not just high-risk patients) were taken into account. Patient-related or disease-related factors could have accounted for such increased rates, as the characteristics of the patients attending the ED could be dissimilar between periods, although the similar rates observed for non-COVID patients in both periods (OR=1.03) does not support this possibility. 

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Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in

Acute Pulmonary Embolism Associated with COVID-19 Pneumonia Detected by Pulmonary CT Angiography

Pulmonary Embolism in COVID-19 Patients: Awareness of an Increased Prevalence

Collaboration among Spanish emergency departments