More than Just Pneumonia: Acute Pulmonary Embolism in Two Middle-Aged Patients with COVID-19

Background. Although severe pneumonia and respiratory compromise have remained the predominant complications of coronavirus disease 19, we are now learning this virus is much more varied in its presentation. In particular, there are increasingly reported cases of thromboembolic events occurring in infected patients. Case Report. In this report, we present two patients, both under the age of 40 with known risk factors for venous thromboembolism, who presented with respiratory distress. Both patients were diagnosed with SARS-CoV-2 pneumonia and pulmonary embolism requiring management with anticoagulation. Both patients were discharged after a short course in the hospital. Conclusion. The discussion of a hypercoagulable state induced by coronavirus disease 19 has been well documented; however, the exact mechanisms remain unknown. We suspect that a prothrombotic inflammatory response provoked by coronavirus disease could be the culprit, acting as an additive effect on middle-aged patients with known risk factors for venous thromboembolism. We recommend clinicians closely monitor those with known risk factors for pulmonary embolism.

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Pulmonary emboli due to venous aneurysm of extremities

VASA ◽

10.1024/0301-1526/a000124 ◽

2011 ◽

Vol 40 (4) ◽

pp. 327-332 ◽

Cited By ~ 6

Author(s):

Gabrielli ◽

Rosati ◽

Vitale ◽

Millarelli ◽

Siani ◽

...

Keyword(s):

Pulmonary Embolism ◽

Surgical Resection ◽

Potential Risk ◽

Acute Pulmonary Embolism ◽

Prophylactic Surgery ◽

Venous Aneurysm ◽

Pulmonary Emboli ◽

Thromboembolic Events ◽

Thromboembolic Complications ◽

Risk Patients

Venous aneurysms are uncommon but they can have devastating consequences, including pulmonary embolism, other thromboembolic events and death. We report six cases of venous aneurysm of the extremities, in which the first sign of presence was acute pulmonary embolism. Surgical resection is recommended whenever possible. Our experience suggests that prophylactic surgery is cautiously recommended for low-risk patients with venous aneurysms of the abdomen and strongly recommended for extremity deep and superficial venous aneurysms for their potential risk of developing thromboembolic complications despite adequate anticoagulation. Other venous aneurysms should be excised only if they are symptomatic or enlarging.

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High Antibody Levels to Prothrombin Imply a Risk of Deep Venous Thrombosis and Pulmonary Embolism in Middle-aged Men

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657711 ◽

1997 ◽

Vol 78 (04) ◽

pp. 1178-1182 ◽

Cited By ~ 59

Author(s):

Timo Palosuo ◽

Jarmo Virtamo ◽

Jari Haukka ◽

Philip R Taylor ◽

Kimmo Aho ◽

...

Keyword(s):

Pulmonary Embolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Plasma Proteins ◽

Alpha Tocopherol ◽

Index Number ◽

Thromboembolic Events ◽

Middle Aged ◽

Phospholipid Binding ◽

Antiprothrombin Antibodies

SummaryAntibodies against phospholipid-binding plasma proteins, such as β2-glycoprotein I (β2-GPI) and prothrombin, are associated with thromboembolic events in patients with systemic lupus erythematosus and also in subjects with no evident underlying diseases. We wanted to examine whether increased levels of antibodies to negatively-charged phospholipids (cardiolipin), to phospholipid-binding plasma proteins β2-GPI and prothrombin and to oxidised low-density lipoprotein (LDL) were associated with risk of deep venous thrombosis or pulmonary embolism in subjects with no previous thrombosis. The antibodies were measured in stored serum samples from 265 cases of deep venous thrombosis of the lower extremity or pulmonary embolism occurring during a median follow-up of about 7 years and from 265 individually matched controls. The study subjects were middle-aged men participating in a cancer prevention trial of alpha-tocopherol and beta-carotene and the cases of thromboembolic events were identified from nationwide Hospital Discharge Register.The risk for thrombotic events was significantly increased only in relation to antiprothrombin antibodies. As adjusted for body mass index, number of daily cigarettes and history of chronic bronchitis, myocardial infarction and heart failure at baseline, the odds ratio per one unit of antibody was 6.56 (95% confidence interval 1.73-25.0). The seven highest individual optical density-unit values of antiprothrombin antibodies were all confined to subjects with thromboembolic episodes.In conclusion, the present nested case-control study showed that high autoantibody levels against prothrombin implied a risk of deep venous thrombosis and pulmonary embolism and could be involved in the development of the thrombotic processes.

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Association of MR-proANP with cardiovascular risk factors in middle aged patients with diabetes mellitus type 2 and non-diabetic controls

Endocrine Abstracts ◽

10.1530/endoabs.63.gp26 ◽

2019 ◽

Author(s):

Simona Chisaliita ◽

Magnus Wijkman ◽

Fredrik Nystrom ◽

Carl Johan Ostgren

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Diabetes Mellitus Type 2 ◽

Diabetes Mellitus Type ◽

Middle Aged ◽

Aged Patients ◽

Patients With Diabetes

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An incidental finding of testicular seminoma in the context of acute pulmonary embolism: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02925-z ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Kaitlin J. Mayne ◽

Emma Lewis ◽

Lewis Vickers

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Clinical Guidelines ◽

Acute Pulmonary Embolism ◽

Incidental Finding ◽

White Male ◽

Vena Cava ◽

Testicular Seminoma ◽

Computed Tomography Scanning ◽

The Right

Abstract Background Clinical guidelines do not recommend further investigation for occult malignancy in the scenario of unprovoked venous thromboembolism in the absence of additional clinical features suggestive of malignancy. We present the case of a young gentleman with pulmonary embolism who was diagnosed with testicular seminoma despite lack of symptoms or signs suggestive of malignancy. This is a unique case describing a scenario not well documented in existing literature where contravention of clinical guidelines had a potentially advantageous outcome for the patient. Case presentation A 37-year-old white male presented with seemingly unprovoked acute pulmonary embolism with right heart strain. He did not have any predisposing factors for venous thromboembolism and did not have any symptoms or signs suggestive of malignancy. Clinical guidelines do not recommend further investigation to screen for malignancy in this scenario. Despite this, our young, otherwise healthy patient proceeded to computed tomography scanning, resulting in the diagnosis of localized testicular seminoma. Testicular ultrasound described normal-sized testes (despite a discrete lesion in the right testis), suggesting this was not detectable by the patient or clinician on routine examination. The patient was anticoagulated and had an inferior vena cava filter inserted to facilitate orchidectomy followed by adjuvant radiotherapy. Conclusions This case highlights the importance of considering malignancy in seemingly unprovoked venous thromboembolism and the availability of guidelines to direct further investigation. Our patient’s treatment was not in line with clinical guidelines and was considered a “lucky find.”

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Delayed pulmonary embolism after COVID-19 pneumonia: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa449 ◽

2020 ◽

Author(s):

Mohamad Kanso ◽

Thomas Cardi ◽

Halim Marzak ◽

Alexandre Schatz ◽

Loïc Faucher ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Index Hospitalization ◽

Rt Pcr ◽

Moderate Severity ◽

Respiratory Status ◽

Case Summary ◽

Pcr Test

Abstract Background Since the onset of the COVID-19 pandemic, several cardiovascular manifestations have been described. Among them, venous thromboembolism (VTE) seems to be one of the most frequent, particularly in intensive care unit patients. We report two cases of COVID-19 patients developing acute pulmonary embolism (PE) after discharge from a first hospitalization for pneumonia of moderate severity. Case summary Two patients with positive RT-PCR test were initially hospitalized for non-severe COVID-19. Both received standard thromboprophylaxis during the index hospitalization and had no strong predisposing risk factors for VTE. Few days after discharge, they were both readmitted for worsening dyspnoea due to PE. One patient was positive for lupus anticoagulant. Discussion Worsening respiratory status in COVID-19 patients must encourage physicians to search for PE since SARS-CoV-2 infection may act as a precipitant risk factor for VTE. Patients may thus require more aggressive and longer thromboprophylaxis after COVID-19 related hospitalization.

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Forty-One-Year-Old Man with Pulmonary Embolism 5 Months After COVID-19

Clinical Medicine Insights Circulatory Respiratory and Pulmonary Medicine ◽

10.1177/1179548420986659 ◽

2021 ◽

Vol 15 ◽

pp. 117954842098665

Author(s):

Muhanad Taha ◽

Paul Nguyen ◽

Aditi Sharma ◽

Mazen Taha ◽

Lobelia Samavati

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

High Risk ◽

Venous Thrombosis ◽

Case Summary ◽

One Year

Background: Hypercoagulation is one of the striking features of COVID-19. Patients hospitalized with COVID-19 are at high risk for venous thromboembolism. However, it is unknown if the risk for venous thromboembolism persists after discharge. Case Summary: We report a case with pulmonary embolism 5 months after COVID-19. No risk factors for venous thrombosis have been identified. Conclusion: In COVID-19 related hospitalization, large studies are needed to identify the risk of venous thromboembolism after discharge.

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The Diagnostic Assessment of Suspected Pulmonary Embolism on the Acute Medical Take: An Evidence Based Guide

Acute Medicine Journal ◽

10.52964/amja.0148 ◽

2007 ◽

Vol 6 (1) ◽

pp. 20-26

Author(s):

Alastair Proudfoot ◽

◽

Derek Bell ◽

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Clinical Presentation ◽

Diagnostic Assessment ◽

Evidence Based ◽

Suspected Pulmonary Embolism ◽

The Subject ◽

Adjusted Incidence ◽

Age And Sex

Pulmonary Embolism is a common cardiopulmonary illness with an age and sex adjusted incidence of around 117 cases per 100 000 person years. The clinical presentation is extremely heterogeneous and non specific. Risk factors for venous thromboembolism are well established. When combined with presenting features and investigations. a multimodality algorithm has led to significant changes in the diagnostic approach of suspected PE. While the best combination of tests for any individual patient remains the subject of controversy this article aims to rationalise the acute physician’s approach to diagnosis and use of available investigations.

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Higher Incidence of Stroke in Severe COVID-19 Is Not Associated With a Higher Burden of Arrhythmias: Comparison With Other Types of Severe Pneumonia

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.763827 ◽

2021 ◽

Vol 8 ◽

Author(s):

Peter Jirak ◽

Zornitsa Shomanova ◽

Robert Larbig ◽

Daniel Dankl ◽

Nino Frank ◽

...

Keyword(s):

Risk Factors ◽

Critically Ill ◽

Critically Ill Patients ◽

Severe Pneumonia ◽

Thromboembolic Events ◽

Therapeutic Anticoagulation ◽

Tertiary Hospitals ◽

Ventricular Tachycardias ◽

Disease Specific ◽

Rhythm Monitoring

Aims: Thromboembolic events, including stroke, are typical complications of COVID-19. Whether arrhythmias, frequently described in severe COVID-19, are disease-specific and thus promote strokes is unclear. We investigated the occurrence of arrhythmias and stroke during rhythm monitoring in critically ill patients with COVID-19, compared with severe pneumonia of other origins.Methods and Results: This retrospective study included 120 critically ill patients requiring mechanical ventilation in three European tertiary hospitals, including n =60 COVID-19, matched according to risk factors for the occurrence of arrhythmias in n = 60 patients from a retrospective consecutive cohort of severe pneumonia of other origins. Arrhythmias, mainly atrial fibrillation (AF), were frequent in COVID-19. However, when compared with non-COVID-19, no difference was observed with respect to ventricular tachycardias (VT) and relevant bradyarrhythmias (VT 10.0 vs. 8.4 %, p = ns and asystole 5.0 vs. 3.3%, p = ns) with consequent similar rates of cardiopulmonary resuscitation (6.7 vs. 10.0%, p = ns). AF was even more common in non-COVID-19 (AF 18.3 vs. 43.3%, p = 0.003; newly onset AF 10.0 vs. 30.0%, p = 0.006), which resulted in a higher need for electrical cardioversion (6.7 vs. 20.0%, p = 0.029). Despite these findings and comparable rates of therapeutic anticoagulation (TAC), the incidence of stroke was higher in COVID-19 (6.7.% vs. 0.0, p = 0.042). These events also happened in the absence of AF (50%) and with TAC (50%).Conclusions: Arrhythmias were common in severe COVID-19, consisting mainly of AF, yet less frequent than in matched pneumonia of other origins. A contrasting higher incidence of stroke independent of arrhythmias also observed with TAC, seems to be an arrhythmia-unrelated disease-specific feature of COVID-19.

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CURRENT VIEW ON ANTICOAGULANT AND THROMBOLYTIC TREATMENT OF ACUTE PULMONARY EMBOLISM

The Russian Archives of Internal Medicine ◽

10.20514/2226-6704-2019-9-5-348-366 ◽

2019 ◽

Vol 9 (5) ◽

pp. 348-366

Author(s):

G. G. Taradin ◽

G. A. Ignatenko ◽

N. T. Vatutin ◽

I. V. Kanisheva

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Acute Pulmonary Embolism ◽

Oral Anticoagulants ◽

Medical Intervention ◽

Bleeding Complications ◽

Current View ◽

Anticoagulant Treatment ◽

Thrombolytic Treatment ◽

Systemic Thrombolysis

The presented review concerns contemporary views on specific aspects of anticoagulant and thrombolytic treatment of venous thromboembolism and mostly of acute pulmonary embolism. Modern classifications of patients with acute pulmonary embolism, based on early mortality risk and severity of thromboembolic event, are reproduced. The importance of multidisciplinary approach to the management of patients with pulmonary embolism with the assistance of cardiologist, intensive care specialist, pulmonologist, thoracic and cardiovascular surgeon, aimed at the management of pulmonary embolism at all stages: from clinical suspicion to the selection and performing of any medical intervention, is emphasized. Anticoagulant treatment with the demonstration of results of major trials, devoted to efficacy and safety evaluation of anticoagulants, is highlighted in details. Moreover, characteristics, basic dosage and dosage scheme of direct (new) oral anticoagulants, including apixaban, rivaroxaban, dabigatran, edoxaban and betrixaban are described in the article. In particular, the management of patients with bleeding complications of anticoagulant treatment and its application in cancer patients, who often have venous thromboembolism, is described. Additionally, modern approaches to systemic thrombolysis with intravenous streptokinase, urokinase and tissue plasminogen activators are presented in this review. The indications, contraindications, results of clinical trials devoted to various regimens of thrombolytic therapy, including treatment of pulmonary embolism by lower doses of fibrinolytic agents, are described.

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