Unexpected Pulmonary Embolism Late After Recovery from Mild COVID-19?

SARS-CoV-2 infection is associated with an increased risk of venous thromboembolism (VTE), which is common during active illness but unusual in milder cases and after healing. We describe a case of bilateral acute pulmonary embolism occurring 3 months after recovery from a paucisymptomatic SARS-CoV-2 infection. The only VTE risk factor demonstrable was a history of previous SARS-CoV-2 infection, with laboratory signs of residual low-grade inflammation. Clinicians should be aware of VTE as a potential cause of sudden dyspnoea after COVID-19 resolution, especially in the presence of persistent systemic inflammation.

Download Full-text

Family history of venous thromboembolism predicts the diagnosis of acute pulmonary embolism in the emergency department

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2018.01.023 ◽

2018 ◽

Vol 36 (9) ◽

pp. 1550-1554 ◽

Cited By ~ 2

Author(s):

Christopher Kelly ◽

Chad Agy ◽

Margaret Carlson ◽

Jacob Steenblik ◽

Joseph Bledsoe ◽

...

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Family History ◽

Acute Pulmonary Embolism ◽

History Of

Download Full-text

Is APC Resistance a Risk Factor for Venous Thromboembolism in Patients over 70 Years?

Thrombosis and Haemostasis ◽

10.1055/s-0037-1613260 ◽

2002 ◽

Vol 88 (10) ◽

pp. 587-591 ◽

Cited By ~ 8

Author(s):

Karine Lacut ◽

Grégoire Le Gal ◽

Patrick Van Dreden ◽

Luc Bressollette ◽

Pierre-Yves Scarabin ◽

...

Keyword(s):

Risk Factor ◽

Venous Thromboembolism ◽

Odds Ratio ◽

Dna Analysis ◽

Activated Protein C ◽

Factor V Leiden ◽

Factor V ◽

Apc Resistance ◽

Increased Risk ◽

History Of

SummaryActivated protein C (APC) resistance is the most common risk factor for venous thromboembolism (VTE). Previous studies mostly analysed patients under 70 years and reported a four-to sevenfold increased risk. This case-control study included consecutive patients referred for a clinical suspicion VTE to our medical unit: 621 patients with a well-documented diagnosis (cases) and 406 patients for which the diagnosis was ruled out and who had no personal history of VTE (controls). APC resistance related to factor V Leiden was defined by either a positive DNA analysis or a positive STA® Staclot APC-R assay. Under 70 years, APC resistance was associated with a threefold increased risk of VTE (odds ratio 3.2, 95% CI, 1.7 to 6.0), whereas in patients over 70 years, it appeared to be no longer a strong risk factor (odds ratio 0.8, 95% CI, 0.4 to 1.7). Age appeared as an effectmeasure modifier with a significant interaction (p = 0.005). Our data suggest that APC resistance is not a risk factor for VTE in elderly.

Download Full-text

Pulmonary embolism: update on management and controversies

BMJ ◽

10.1136/bmj.m2177 ◽

2020 ◽

pp. m2177 ◽

Cited By ~ 2

Author(s):

Lisa Duffett ◽

Lana A Castellucci ◽

Melissa A Forgie

Keyword(s):

Pulmonary Embolism ◽

Risk Factor ◽

Venous Thromboembolism ◽

Recurrent Events ◽

Vitamin K Antagonists ◽

Chronic Thromboembolic Pulmonary Hypertension ◽

Therapeutic Options ◽

Systemic Thrombolysis ◽

Catheter Directed Thrombolysis ◽

Increased Risk

ABSTRACTPulmonary embolism is a common and potentially fatal cardiovascular disorder that must be promptly diagnosed and treated. The diagnosis, risk assessment, and management of pulmonary embolism have evolved with a better understanding of efficient use of diagnostic and therapeutic options. The use of either clinical probability adjusted or age adjusted D-dimer interpretation has led to a reduction in diagnostic imaging to exclude pulmonary embolism. Direct oral anticoagulation therapies are safe, effective, and convenient treatments for most patients with acute venous thromboembolism, with a lower risk of bleeding than vitamin K antagonists. These oral therapeutic options have opened up opportunities for safe outpatient management of pulmonary embolism in selected patients. Recent clinical trials exploring the use of systemic thrombolysis in intermediate to high risk pulmonary embolism suggest that this therapy should be reserved for patients with evidence of hemodynamic compromise. The role of low dose systemic or catheter directed thrombolysis in other patient subgroups is uncertain. After a diagnosis of pulmonary embolism, all patients should be assessed for risk of recurrent venous thromboembolism to guide duration of anticoagulation. Patients with a venous thromboembolism associated with a strong, transient, provoking risk factor can safely discontinue anticoagulation after three months of treatment. Patients with an ongoing strong risk factor, such as cancer, or unprovoked events are at increased risk of recurrent events and should be considered for extended treatment. The use of a risk prediction score can help to identify patients with unprovoked venous thromboembolism who can benefit from extended duration therapy. Despite major advances in the management of pulmonary embolism, up to half of patients report chronic functional limitations. Such patients should be screened for chronic thromboembolic pulmonary hypertension, but only a small proportion will have this as the explanation of their symptoms. In the remaining patients, future studies are needed to understand the pathophysiology and explore interventions to improve quality of life.

Download Full-text

Family History of Venous Thromboembolism As a Risk Factor for Thrombosis in Multiple Myeloma Patients: A Population-Based Study,

Blood ◽

10.1182/blood.v118.21.3987.3987 ◽

2011 ◽

Vol 118 (21) ◽

pp. 3987-3987

Author(s):

Sigurdur Y Kristinsson ◽

Lynn Goldin ◽

Ingemar Turesson ◽

Magnus Bjorkholm ◽

Ola Landgren

Keyword(s):

Multiple Myeloma ◽

Risk Factor ◽

Venous Thromboembolism ◽

Family History ◽

Large Population ◽

Population Based ◽

Population Based Study ◽

Increased Risk ◽

History Of ◽

The Impact

Abstract Abstract 3987 Background: Patients with multiple myeloma are at an increased risk of venous thromboembolism (VTE), especially when treated with thalidomide and lenalidomide. The etiology of this is largely unknown, but probably involves both genetic and environmental factors. Family history of VTE is a known risk factor for VTE in the general population, including known inherited thrombophilic abnormalities. The influence of a family history of VTE as a potential risk factor for VTE in multiple myeloma patients is unknown. To expand our knowledge on this topic, we conducted a large population-based study based on all multiple myeloma patients diagnosed in Sweden 1958–2004. Patients and Methods: We assessed the impact of family history of VTE as a risk factor for VTE among 21,067 multiple myeloma patients and 83,094 matched controls. Data on multiple myeloma patients was gathered from the Swedish Cancer Registry, information on first-degree relatives from the national Multigenerational Registry, and occurrence of VTE from the nationwide Patient Registry. We calculated odds ratios (OR) and 95% confidence intervals (CI) using chi-square. Results: Of the 21,067 multiple myeloma patients included in the study (54% males, median age at diagnosis 71 years), 66% had an identifiable first-degree relative. VTE was diagnosed in 1,429 multiple myeloma patients, and 921 had a family history of VTE. Compared to multiple myeloma patients without a family history of VTE, multiple myeloma patients with a family history of VTE had a 2.2-fold (95% CI 1.8–2.7; p<0.001) higher risk of VTE. Among 4,986 controls that were diagnosed with VTE, 316 had a family history of VTE. Controls with a family history of VTE had a 1.5-fold (95% CI 1.3–1.7; p<0.001) increased risk of VTE compared to controls without a family history of VTE. The difference of the impact of family history of VTE on the risk of VTE in multiple myeloma patients versus controls was significant. Summary and Conclusions: In this large population-based study including more than 20,000 multiple myeloma patients, we found family history of VTE to have a larger impact on VTE risk in multiple myeloma than in matched controls. Our findings confirm that genetic factors contribute to thrombophilia in multiple myeloma and may have therapeutic implications regarding thromboprophylaxis and treatment. Disclosures: No relevant conflicts of interest to declare.

Download Full-text

Individually Tailored Prophylaxis Using a Risk Score for the Management of Pregnant Women with Increased Risk of Venous Thromboembolism

Blood ◽

10.1182/blood.v126.23.889.889 ◽

2015 ◽

Vol 126 (23) ◽

pp. 889-889

Author(s):

Yesim G. Dargaud ◽

Lucia Rugeri ◽

Chloe Fleury ◽

Helene Desmurs Clavel ◽

Jacques Ninet ◽

...

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

High Risk ◽

Prospective Study ◽

Pregnant Women ◽

Risk Score ◽

Personal History ◽

Vein Thrombosis ◽

Increased Risk ◽

History Of

Abstract Patients with thrombophilia and/or a history of venous thromboembolism (VTE) exhibit a high risk of thrombosis during pregnancy. A risk score for pregnancies with increased risk of VTE was previously described by our group (1,2). The present work reports the results of a prospective study, evaluating the efficacy and the safety of the prophylaxis strategy based on the same risk score, in 542 pregnancies at high risk of VTE, managed between 2005 and 2015 in Lyon University Hospitals. Among 445 patients included in the study, 26 had several pregnancies during the study period. The mean age of the study population was 33±4.8 years, 132 women (29.7%) were older than 35 years. Fifty three women had a BMI of 30 or over and 61 were smokers. Among these 445 patients, 279 had a personal history of VTE (62.7%), 299 patients (67.2%) had a thrombophilia marker and 131 (29.4%) thrombophilic women had a personal history of VTE. During pregnancy, patients were assigned to one of three prophylaxis strategies according to the risk scoring system. Compression stockings were worn by the majority of the patients throughout the pregnancy and during the postpartum. In antepartum, LMWH prophylaxis was prescribed to 64.5% of patients with high risk of VTE. Among them, 34.4% were treated in the third trimester only and 30.1% were treated throughout pregnancy. In postpartum, all patients received low molecular weight heparin (LMWH) prophylaxis for at least 6 weeks. In this cohort, two antepartum-related VTE (0.37%) and four postpartum-related VTE (0.73%) occurred. One of the ante-partum related VTE was occurred in a patient who was on LMWH prophylaxis with enoxaparin 40mg/day for a personal history of spontaneous pulmonary embolism and homozygous prothrombin G20210A mutation. Despite well conducted LMWH prophylaxis, the patient had a distal deep vein thrombosis (DVT) at week 28. The second VTE was a proximal DVT during a bed resting in the eighth month of pregnancy in a patient with heterozygous FV Leiden mutation and a history of proximal DVT. According to the risk score, LMWH prophylaxis was required during bed-resting but it was not prescribed by the obstetrician. Among four postpartum-related VTE, 3 occurred after the 6 weeks of LMWH prophylaxis, between weeks 8 and 12 of the postpartum period and one was a ovarian vein thrombosis. No case of pulmonary embolism was observed during the study period. The rate of bleeding was 0.37%, no serious bleeding requiring transfusions or surgery was occurred during the study period. There was no evidence of heparin-induced thrombocytopenia or osteoporosis. The use of a risk score may provide a rational decision process to implement safe and effective antepartum thromboprophylaxis in pregnant women at high risk of VTE Dargaud, Y., Rugeri, L., Ninet, J., Negrier, C. & Trzeciak, M.C. Management of pregnant women with increased risk of venous thrombosis. International Journal of Gynaecology and Obstetrics 2005, 90,203-207 Dargaud, Y., Rugeri, L., Vergnes MC, Arnuti B, Miranda P, Negrier, C., Ninet, J., Trzeciak, M.C. A risk score for the management of pregnant women with increased risk of venous thrombomebolism: a multicenter prospective study. Br J Haematol 2009;145:825-35 Disclosures No relevant conflicts of interest to declare.

Download Full-text

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.”

Download Full-text

Familial thrombophilia associated with fibrinogen Paris V: Dusart syndrome

Blood ◽

10.1182/blood.v96.3.1191 ◽

2000 ◽

Vol 96 (3) ◽

pp. 1191-1193 ◽

Cited By ~ 15

Author(s):

Takashi Tarumi ◽

Danko Martincic ◽

Anne Thomas ◽

Robert Janco ◽

Mary Hudson ◽

...

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Early Onset ◽

Family Members ◽

Initial Presentation ◽

Pulmonary Emboli ◽

Common Cause ◽

History Of ◽

Prophylactic Anticoagulation ◽

Fibrin Clots

Abstract We report on a family with a history of venous thromboembolism associated with fibrinogen Paris V (fibrinogen A-Arg554→Cys). Ten members experienced thrombotic events, including 4 with fatal pulmonary emboli. Pulmonary embolism was the presenting feature in 4. Those with the mutation and a history of thrombosis had somewhat higher fibrinogen concentrations than those with the mutation and no thrombosis (294 ± 70 mg/dL vs 217 ± 37 mg/dL, respectively). The Paris V mutation consistently caused a prolongation of the reptilase time, and fibrin clots containing the abnormal fibrinogen were more translucent than normal clots. Given the early onset of symptoms and the initial presentation with pulmonary embolism in some family members, it was justifiable to offer prophylactic anticoagulation with warfarin to carriers of the mutation. Fibrinogen Paris V has now been reported in 4 apparently unrelated families, indicating that it is a relatively common cause of dysfibrinogenemia-associated thrombosis.

Download Full-text

SARS-CoV-2 and Obesity: “CoVesity”—a Pandemic Within a Pandemic

Obesity Surgery ◽

10.1007/s11695-020-04919-0 ◽

2021 ◽

Author(s):

Kimberley Zakka ◽

◽

Swathikan Chidambaram ◽

Sami Mansour ◽

Kamal Mahawar ◽

...

Keyword(s):

Systematic Review ◽

Risk Factor ◽

Viral Load ◽

Respiratory Failure ◽

Health Outcomes ◽

Severe Disease ◽

Vulnerable Population ◽

Low Grade ◽

Obesity Management ◽

Low Grade Inflammation

AbstractIndividuals who are overweight or suffering from obesity are in a chronic state of low-grade inflammation, making them particularly susceptible to developing severe forms of respiratory failure. Studies conducted in past pandemics link obesity with worse health outcomes. This population is thus of particular concern within the context of the COVID-19 pandemic, considering the cessation of obesity management services. This systematic review highlights [1] the reciprocal link between the obesity and COVID-19 pandemics, [2] obesity as a risk factor for more severe disease in past pandemics, [3] potential mechanisms that make individual’s suffering from obesity more susceptible to severe disease and higher viral load, and [4] the need to safely resume bariatric services as recommended by expert guidelines, in order to mitigate the health outcomes of an already vulnerable population.

Download Full-text

The prognostic efficacy of beta2-microglobulin in acute pulmonary embolism

Acute Medicine Journal ◽

10.52964/amja.0655 ◽

2017 ◽

Vol 16 (2) ◽

pp. 52-59

Author(s):

Sotirios Kakavas ◽

◽

Aggeliki Papanikolaou ◽

Evangelos Balis ◽

Evgenios Metaxas ◽

...

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

C Reactive Protein ◽

Reactive Protein ◽

Risk Of Death ◽

Increased Risk ◽

Preliminary Study ◽

Wbc Count ◽

A Prospective Study ◽

Acute Pe

Our aim was to prospectively assess the prognostic value of beta2- microglobulin (b2-M) in patients with acute pulmonary embolism (PE). We conducted a prospective study of 109 patients admitted in a pulmonary clinic due to acute PE. A panel of inflammatory markers including b2-M white blood cell (WBC) count and C-reactive protein (CRP) was determined for each patient. In this preliminary study, baseline b2-M levels significantly correlated with the impairment of oxygenation and with all the parameters that are used for the early risk stratification of patients. In multivariate analysis, patients’ age and baseline b2-M levels were significantly associated with an increased risk of death. These findings require further prospective validation.

Download Full-text

Decreased anticoagulant response to tissue factor pathway inhibitor in patients with venous thromboembolism and otherwise no evidence of hereditary or acquired thrombophilia

Thrombosis and Haemostasis ◽

10.1160/th03-05-0329 ◽

2004 ◽

Vol 91 (01) ◽

pp. 80-86 ◽

Cited By ~ 8

Author(s):

Brigitte Piccapietra ◽

Johanna Boersma ◽

Joerg Fehr ◽

Thomas Bombeli

Keyword(s):

Venous Thromboembolism ◽

Venous Thrombosis ◽

Mean Value ◽

Healthy Controls ◽

Crude Odds Ratio ◽

Sensitivity Ratio ◽

Increased Risk ◽

History Of ◽

Anticoagulant Response ◽

Acquired Thrombophilia

SummaryNo relevant deficiency of TFPI or genetic polymorphisms could thus far consistently be associated with venous thromboembolism. We hypothesized that the substrates of the TFPI protein, including FVII or FX (rather than the protein itself) could induce a hypercoagulable state. We created a novel TF-based clotting assay that evaluated the anticoagulant response to exogenously added recombinant TFPI. The response to TFPI was expressed as the ratio of the clotting time with and without TFPI. By using 118 healthy controls, we established a reference range between 1.31 and 1.93 (mean value ± 2 standard deviations (SD), 1.62 ± 0.31). We then evaluated samples from 120 patients with a history of venous thromboembolism but no evidence of hereditary and acquired thrombophilia. The range of the patients’ ratios was significantly (P < 0.001) lower, falling between 1.2 and 1.78 (mean value ± 2 SD, 1.49 ± 0.29). Of the 120 patients, 39 (32.5%) had a TFPI sensitivity ratio below the 10th percentile of the controls, compared with 11 (9.3%) of the healthy controls. The crude odds ratio for venous thrombosis for subjects with a TFPI sensitivity ratio below the 10th percentile was 13 (95% CI; range, 3.1 to 54.9) compared with those with a ratio above 1.8 (90th percentile). Patients with idiopathic thromboembolism did not have a decreased TFPI sensitivity ratio more often than patients with thrombosis with a circumstantial risk factor. Based on these results, a reduced response to TFPI may lead to an increased risk of venous thrombosis.

Download Full-text