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      COVID-19 complicated by pulmonary embolism treated with catheter directed thrombectomy

      case-report

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          Abstract

          Summary: COVID-19 is a recently identified illness that is associated with thromboembolic events. We report a case of pulmonary embolism in a patient with COVID-19, treated by catheter directed thrombectomy. A 57 year old patient presented to the emergency center with severe COVID-19 symptoms and developed massive pulmonary embolism. The patient was treated with catheter directed thrombolysis (CDT) and recovered completely. Coagulopathy associated with COVID-19 is present in all severe cases and is a dynamic process. We describe a case of massive/high risk pulmonary embolism, in a patient with COVID-19 receiving full anticoagulation, who was treated by percutaneous intervention. CDT can be an additional therapeutic option in patients with COVID-19 and pulmonary embolism that present with rapid clinical collapse.

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          Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

          Zunyou Wu, Jennifer M. McGoogan (2020)
          Article 0 comments Cited 8650 times – based on 0 reviews     Review now
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            Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia

            Ning Tang, Dengju Li, Xiong Wang … (2020)
            Abstract Background In the recent outbreak of novel coronavirus infection in Wuhan, China, significantly abnormal coagulation parameters in severe novel coronavirus pneumonia (NCP) cases were a concern. Objectives To describe the coagulation feature of patients with NCP. Methods Conventional coagulation results and outcomes of 183 consecutive patients with confirmed NCP in Tongji hospital were retrospectively analyzed. Results The overall mortality was 11.5%, the non‐survivors revealed significantly higher D‐dimer and fibrin degradation product (FDP) levels, longer prothrombin time and activated partial thromboplastin time compared to survivors on admission (P < .05); 71.4% of non‐survivors and 0.6% survivors met the criteria of disseminated intravascular coagulation during their hospital stay. Conclusions The present study shows that abnormal coagulation results, especially markedly elevated D‐dimer and FDP are common in deaths with NCP.
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              Incidence of thrombotic complications in critically ill ICU patients with COVID-19

              F.A. Klok, M.J.H.A. Kruip, N.J.M. van der Meer … (2020)
              Introduction COVID-19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation. Reports on the incidence of thrombotic complications are however not available. Methods We evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction or systemic arterial embolism in all COVID-19 patients admitted to the ICU of 2 Dutch university hospitals and 1 Dutch teaching hospital. Results We studied 184 ICU patients with proven COVID-19 pneumonia of whom 23 died (13%), 22 were discharged alive (12%) and 139 (76%) were still on the ICU on April 5th 2020. All patients received at least standard doses thromboprophylaxis. The cumulative incidence of the composite outcome was 31% (95%CI 20-41), of which CTPA and/or ultrasonography confirmed VTE in 27% (95%CI 17-37%) and arterial thrombotic events in 3.7% (95%CI 0-8.2%). PE was the most frequent thrombotic complication (n = 25, 81%). Age (adjusted hazard ratio (aHR) 1.05/per year, 95%CI 1.004-1.01) and coagulopathy, defined as spontaneous prolongation of the prothrombin time > 3 s or activated partial thromboplastin time > 5 s (aHR 4.1, 95%CI 1.9-9.1), were independent predictors of thrombotic complications. Conclusion The 31% incidence of thrombotic complications in ICU patients with COVID-19 infections is remarkably high. Our findings reinforce the recommendation to strictly apply pharmacological thrombosis prophylaxis in all COVID-19 patients admitted to the ICU, and are strongly suggestive of increasing the prophylaxis towards high-prophylactic doses, even in the absence of randomized evidence.
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                Author and article information

                Contributors
                Marcela Juliano Silva:
                ORCID: https://orcid.org/0000-0002-0886-8184
                Journal
                Journal ID (publisher): vas
                Title: VASA
                Subtitle: European Journal of Vascular Medicine
                Publisher: Hogrefe AG, Bern
                ISSN (Print): 0301-1526
                ISSN (Electronic): 1664-2872
                Publication date (Electronic): May 28, 2020
                Publication date (Print): 2020
                Volume: 49
                Issue: 4
                Pages: 333-337
                Affiliations
                [ 1 ]Interventional Medicine Center, Hospital Israelita Albert Einstein, São Paulo, Brazil
                [ 2 ]Department of Pneumology, Hospital Israelita Albert Einstein, São Paulo, Brazil
                [ 3 ]Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
                Author notes
                Marcela Juliano Silva, Av Albert Einstein 627, 05652900 Sao Paulo, Brazil, E-mail marcelajuliano90@ 123456gmail.com
                Author information
                https://orcid.org/0000-0002-0886-8184
                Article
                ApaID ID: vas_49_4_333
                DOI: 10.1024/0301-1526/a000880
                SO-VID: 4b9deab6-3963-41da-a2bd-7398d85da1c0
                Copyright statement: Copyright @ 2020
                History
                Date received : May 6, 2020
                Date accepted : May 12, 2020
                Categories
                Subject: Case report

                ScienceOpen disciplines: Medicine
                Keywords: pulmonary embolism,anticoagulants,mechanical thrombolysis,thrombectomy,COVID-19
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: pulmonary embolism, anticoagulants, mechanical thrombolysis, thrombectomy, COVID-19

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