scholarly journals Pulmonary embolism in patients with severe COVID-19 treated with intermediate- to full-dose enoxaparin

2020 ◽  
Author(s):  
Cleante Scarduelli ◽  
Francesco Inglese ◽  
Massimiliano Beccaria ◽  
Fabio Spreafico ◽  
Martina Garuti ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Respiratory Failure ◽  
Case Series ◽  
Pulmonary Angiography ◽  
Arterial Oxygen ◽  
Positive Pressure ◽  
Severe Respiratory Failure ◽  
Retrospective Case ◽  
Full Dose ◽  
D Dimer

Abstract Background: Coronavirus disease 2019 (COVID-19) may predispose patients to venous thromboembolism (VTE) due to inflammation, hypoxia, immobilization, and diffuse intravascular coagulation, despite standard thrombopropylaxis. Our retrospective study reports the incidence of pulmonary embolism (PE) in patients with COVID-19 and severe respiratory failure(SRF) treated with intermediate to full-dose enoxaparin. .Methods: This retrospective case series analysed data from patients with COVID-19 pneumonia and severe respiratory failure (SRF) admitted to our Respiratory Intensive Care Unit (RICU) between February 27 and April 20, 2020 for non-invasive positive-pressure ventilation. All patients received at least intermediate-dose enoxaparin (40 mg twice daily). If PE was suspected or diagnosed, patients were treated with full-dose enoxaparin (1 mg/kg twice daily). Computed tomography pulmonary angiography (CTPA) was used to detect PE in patients with elevated D-dimer levels (> 3000 ng/mL) and/or other clinical indicators, including sudden worsening of cardiopulmonary status.Results: Ninety-two patients (71 males, 21 females; mean age 58 ± 11 years) with COVID-19 pneumonia and SRF (mean arterial oxygen partial pressure/fractional inspired oxygen [PaO2/FiO2] of 143 ± 45 mm Hg) were admitted to our RICU. Twenty-two patients underwent CTPA (24%), with PEs detected in 11 (12%). Mean PaO2/FiO2 and mean D-dimer levels did not significantly differ between patients with or without PE. Eleven patients (12%) died in the hospital, with a mean age of 70 ± 11 years for deceased patients and 56 ± 11 years for surviving patients (p < 0.0001).Conclusions: PE was diagnosed in 12% of patients despite intermediate to full-dose enoxaparin treatment. However the incidence of PE in our patients was lower than that previously reported. We hypothesize that this reduced PE incidence may have been secondary to the higher than prophylactic enoxaparin dose that was used.

scholarly journals Venous Doppler Ultrasound in Critically Ill Covid-19 Patients: Game Changer in Anticoagulation Therapy

2020 ◽  
Author(s):  
Marta Alfageme ◽  
Jorge González Plaza ◽  
María Luisa Collado ◽  
Santiago Méndez ◽  
Juan A. Gómez Patiño ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Respiratory Failure ◽  
Critically Ill ◽  
Doppler Ultrasound ◽  
Acute Pulmonary Embolism ◽  
Anticoagulation Therapy ◽  
Lower Limbs ◽  
Severe Respiratory Failure ◽  
Asymptomatic Patients ◽  
D Dimer

Abstract BackgroundCOVID-19 infection has been associated with a high rate of thrombotic events, such as deep vein thrombosis (DVT) and acute pulmonary embolism (APE).MethodsThe purpose of our retrospective study was to evaluate the prevalence of asymptomatic DVT in lower limbs in critically ill COVID-19 patients (n=23) with severe respiratory failure and high levels of D-dimer by bedside Doppler ultrasound (DU).ResultsDVT was diagnosed in 14 cases (60.87%), 5 in proximal venous territory and 9 in infrapopliteal veins. CTPA was performed in 6 patients and all of them showed acute pulmonary embolism (APE) at segmental or subsegmental branches of pulmonary arteries. These patients (APE or DVT confirmed) were treated with therapeutic doses of anticoagulant therapy.ConclusionIn critically COVID 19 ill ICU patients with severe respiratory failure y elevated D-dimer the incidence of asymptomatic DVT is high. We propose that DU allows detection of DVT in asymptomatic patients, adding a factor that may balance the decision to fully anticoagulated these patients.

scholarly journals Venous Doppler ultrasound in critically Ill COVID-19 patients: game changer in anticoagulation therapy

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Marta Alfageme ◽  
Jorge González Plaza ◽  
Santiago Méndez ◽  
Juan A. Gómez Patiño ◽  
María L. Collado ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Respiratory Failure ◽  
Critically Ill ◽  
Doppler Ultrasound ◽  
Acute Pulmonary Embolism ◽  
Anticoagulation Therapy ◽  
Lower Limbs ◽  
Severe Respiratory Failure ◽  
Asymptomatic Patients ◽  
D Dimer

Abstract Background COVID-19 infection has been associated with a high rate of thrombotic events, such as deep vein thrombosis (DVT) and acute pulmonary embolism (APE). Methods The purpose of our retrospective study was to evaluate the prevalence of asymptomatic DVT in lower limbs in critically ill COVID-19 patients (n = 23) with severe respiratory failure and high levels of D-dimer by bedside Doppler ultrasound (DU). Results DVT was diagnosed in 14 cases (60.87%), 5 in proximal venous territory and 9 in infrapopliteal veins. Computed Tomography Pulmonary Angiography (CTPA) was performed in six patients and all of them showed acute pulmonary embolism (APE) at segmental or subsegmental branches of pulmonary arteries. These patients (APE or DVT confirmed) were treated with therapeutic doses of anticoagulant therapy. Conclusion In critically COVID-19 ill ICU patients with severe respiratory failure and elevated D-dimer, the incidence of asymptomatic DVT is high. We propose that DU allows detection of DVT in asymptomatic patients, adding a factor that may balance the decision to fully anticoagulate these patients.

scholarly journals The Use of Inhaled Epoprostenol for Acute Respiratory Distress Syndrome Secondary due to COVID-19: A Case Series

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Komal Imtiaz ◽  
Wade Jodeh ◽  
Dave Sudekum ◽  
Bruno DiGiovine ◽  
Jason Hecht
Keyword(s):  
Respiratory Failure ◽  
Small Sample Size ◽  
Case Series ◽  
Small Sample ◽  
Teaching Hospitals ◽  
Arterial Oxygen ◽  
Severe Respiratory Failure ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Pulmonary Vasodilator

Abstract Introduction Inhaled epoprostenol (iEpo) is a pulmonary vasodilator used to treat refractory respiratory failure, including that caused by Coronavirus 2019 (COVID-19) pneumonia. Aim of Study To describe the experience at three teaching hospitals using iEpo for severe respiratory failure due to COVID-19 and evaluate its efficacy in improving oxygenation. Methods Fifteen patients were included who received iEpo, had confirmed COVID-19 and had an arterial blood gas measurement in the 12 hours before and 24 hours after iEpo initiation. Results Eleven patients received prone ventilation before iEpo (73.3%), and six (40%) were paralyzed. The partial pressure of arterial oxygen to fraction of inspired oxygen (P/F ratio) improved from 95.7 mmHg to 118.9 mmHg (p=0.279) following iEpo initiation. In the nine patients with severe ARDS, the mean P/F ratio improved from 66.1 mmHg to 95.7 mmHg (p=0.317). Ultimately, four patients (26.7%) were extubated after an average of 9.9 days post-initiation. Conclusions The findings demonstrated a trend towards improvement in oxygenation in critically ill COVID-19 patients. Although limited by the small sample size, the results of this case series portend further investigation into the role of iEpo for severe respiratory failure associated with COVID-19.

scholarly journals Efficacy of D-Dimer Assay in Pulmonary Venous Thromboembolism: Study of 76 Cases

2021 ◽  
Author(s):  
Shubhi Saxena ◽  
Nishant Saxena ◽  
Richa Jain ◽  
Jasmin Jasani
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Predictive Value ◽  
Wide Spectrum ◽  
Pulmonary Angiography ◽  
Retrospective Case ◽  
One Year ◽  
Sensitivity Specificity ◽  
D Dimer

Introduction: Venous Thromboembolism (VTE) encompasses a wide spectrum consisting predominantly of deep venous thrombosis and pulmonary embolism. The value of Fibrin Degradation Product (FDP) of which, most common is D-dimer which is most commonly deployed to pre-diagnose venous thrombosis. Diagnosing it has always been a hard effort. It is produced when cross-linked fibrin is broken down; among patient who is suspected of having pulmonary embolism, blood D-dimer levels correlate with the probability of having pulmonary embolism. Aim: This study was done to analyse the sensitivity of plasma D-dimer for VTE. Materials and Methods: Retrospective case study of 76 patients with VTE in form of pulmonary embolism done at the Dhiraj Hospital, Sumandeep Vidyapeeth Deemed University, Vadodara from January 2019 to January 2020 for a period of one year. Prethrombolytic plasma was withdrawn and D-dimer quantification were measured using fully automatic stago coagulometer instruement (STA Compact Max). Sensitivity, Specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV) was calculated and formulated in tables and graphs. Results: The sensitivity, NPV, specificity and PPV of the D-dimer was 95.65%, 76.92%, 66.66% and 92.95%, respectively. CT pulmonary angiography had a specificity of 80%, sensitivity of 92.75%, a NPV of 70.58% and a PPV of 95.52%. Conclusion: D-dimer is mostly the go to test for ruling out VTE especially pulmonary embolism, if the pre-test probability is intermediate. Rationale use of this test does help in prognostification and helps to achieve therapeutics faster and more effectively.

scholarly journals Pulmonary embolism in patients with severe COVID-19 treated with intermediate- to full-dose enoxaparin: A retrospective study

2021 ◽  
Author(s):  
Cleante Scarduelli ◽  
Francesco Inglese ◽  
Massimiliano Beccaria ◽  
Fabio Speafico ◽  
Martina Garuti ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Retrospective Study ◽  
Small Sample Size ◽  
Pulmonary Angiography ◽  
Small Sample ◽  
Severe Respiratory Failure ◽  
Computed Tomography Pulmonary Angiography ◽  
Full Dose ◽  
Respiratory Intensive Care Unit ◽  
Intermediate Dose

Coronavirus disease (COVID-19) may predispose patients to pulmonary embolism (PE), despite standard thromboprophylaxis. Our retrospective study aimed to report the prevalence of PE in patients with COVID-19 and severe respiratory failure (SRF) treated with intermediate- to full-dose enoxaparin. We analyzed data from patients with COVID-19 pneumonia and SRF admitted to our Respiratory Intensive Care Unit (RICU) from February 27 to April 20, 2020. All patients received at least intermediate-dose enoxaparin (40 mg twice daily). Computed tomography pulmonary angiography (CTPA) was used to detect PE. Ninety-two patients with COVID-19 pneumonia and SRF were admitted to our RICU. Twenty-two patients underwent CTPA (24 %), 11 of whom had PEs (12%). We hypothesize that the enoxaparin treatment may be responsible for the lower prevalence of PE as compared to previous reports of similar patients, even if our report had several limitations, mainly the small sample size.

scholarly journals CT pulmonary angiography in COVID-19 pneumonia: relationship between pulmonary embolism and disease severity

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Aya Yassin ◽  
Maryam Ali Abdelkader ◽  
Rehab M. Mohammed ◽  
Ahmed M. Osman
Keyword(s):  
Pulmonary Embolism ◽  
Disease Severity ◽  
Laboratory Data ◽  
Pulmonary Angiography ◽  
Significant Relation ◽  
Ct Pulmonary Angiography ◽  
Laboratory Results ◽  
Severity Of The Disease ◽  
The Relationship ◽  
D Dimer

Abstract Background Pulmonary embolism (PE) is one of the known sequels of COVID-19 infection. We aimed to assess the incidence of PE in patients with COVID-19 infection and to evaluate the relationship between the CT severity of the disease and the laboratory indicators. This was a retrospective study conducted on 96 patients with COVID-19 infection proved by positive PCR who underwent CT pulmonary angiography (CTPA) with a calculation of the CT severity of COVID-19 infection. Available patients’ complaint and laboratory data at the time of CTPA were correlated with PE presence and disease severity. Results Forty patients (41.7%) showed positive PE with the median time for the incidence of PE which was 12 days after onset of the disease. No significant correlation was found between the incidence of PE and the patients’ age, sex, laboratory results, and the CT severity of COVID-19. A statistically significant relation was found between the incidence of PE and the patients’ desaturation, hemoptysis, and chest pain. A highly significant correlation was found between the incidence of PE and the rising in the D-dimer level as well as the progressive CT findings when compared to the previous one. Conclusion CT progression and the rising in D-dimer level are considered the most important parameters suggesting underlying PE in patients with positive COVID-19 infection which is commonly seen during the second week of infection and alert the use of CT pulmonary angiography to exclude or confirm PE. This is may help in improving the management of COVID-19 infection.

scholarly journals CORRELATION OF D-DIMER LEVEL WITH THE PRESENCE AND SEVERITY OF PULMONARY EMBOLISM ON COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY

2020 ◽  
pp. 33-34
Author(s):  
Mantavya Patel ◽  
Sanjay Paliwal ◽  
Rachit Saxena
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Early Diagnosis ◽  
Pulmonary Angiography ◽  
Clinical Suspicion ◽  
Early Prediction ◽  
Computed Tomography Pulmonary Angiography ◽  
Negative Prediction ◽  
D Dimer

Introduction: Early diagnosis of pulmonary embolism can reduce morbidity and motility. D-dimer is well known parameter having high negative prediction value. This study focused on role of D-dimer in early prediction of presence and severity of pulmonary embolism. Material and Methods: Thirty patients with clinical suspicion of pulmonary embolism along with high D-dimer value were included in this study. All selected patients underwent computed tomography pulmonary angiography assessment. D-dimer value was correlated with presence and proximity of pulmonary embolism. Results: Out of thirty selected patients 50% had pulmonary embolism on computed tomography pulmonary angiography assessment. D-dimer value correlated well with presence and proximity of pulmonary embolism. Conclusion: D-dimer value more than 4000 ng/ml had high positive prediction value (79%) in suspected clinical cases. Value more than 8000 ng/ml further improve value to nearly 100% in suspected cases.

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