tetano
Editor, Senior Moderator
J Vasc Surg Venous Lymphat Disord
. 2022 Jan 24;S2213-333X(22)00002-6.
doi: 10.1016/j.jvsv.2021.12.086. Online ahead of print.
Resolution of Acute Pulmonary Embolism using anticoagulation therapy alone in Coronavirus Disease 2019
Charles A Ritchie[SUP] 1 [/SUP], Margaret M Johnson[SUP] 2 [/SUP], Justin T Stowell[SUP] 1 [/SUP], Hajra Idrees[SUP] 1 [/SUP], Beau Toskich[SUP] 1 [/SUP], Ricardo Paz-Fumagalli[SUP] 1 [/SUP], Seyed Montazeri[SUP] 1 [/SUP], Susana Fortich[SUP] 3 [/SUP], Camila Franco-Mesa[SUP] 3 [/SUP], Peter Gloviczki[SUP] 4 [/SUP], Haraldur Bjarnason[SUP] 5 [/SUP], Candido Rivera[SUP] 6 [/SUP], Marwan Shaikh[SUP] 6 [/SUP], Pablo Moreno-Franco[SUP] 7 [/SUP], Devang Sanghavi[SUP] 7 [/SUP], Christopher P Marquez[SUP] 8 [/SUP], Robert D McBane[SUP] 9 [/SUP], Myung S Park[SUP] 10 [/SUP], John C O'Horo[SUP] 11 [/SUP], James F Meschia[SUP] 12 [/SUP], Young Erben[SUP] 13 [/SUP]
Affiliations
Abstract
Objective: To investigate the radiographic resolution of acute pulmonary embolism (PE) using contrast enhanced computed tomography (CECT) examinations in patients diagnosed with acute PE while hospitalized with coronavirus 2019 (COVID-19) disease and to understand the mid-term/long-term implications of anticoagulation therapy.
Methods: We identified patients with acute PE per CECT and at least one follow-up CECT from 3/11/2020 to 5/27/2021 using a prospective registry of all hospitalized patients with COVID-19 infection receiving care within a multicenter Health System. Initial and follow-up CECT examinations were reviewed independently by two radiologists to evaluate for PE resolution. The modified Miller score (MMS) was used to assess for thrombus burden at diagnosis and on follow-up.
Results: Of the 6070 hospitalized patients with COVID-19 infection, 5.7% (348/6070) were diagnosed with acute PE. 13.5% (47/348) had a follow-up CECT examination. Mean (SD) time to follow-up imaging was 44 (48) days (range: 3-161 days). 72.3% (34/47) of patients had radiographic resolution of PE, with a mean time to follow-up of 48 (43) days (range: 6-239 days). All patients received anticoagulation monotherapy for a mean of 149 (95) days and this included apixaban (63.8%), warfarin (12.8%) and rivaroxaban (8.5%) among others. The mean MMS at PE diagnosis and follow-up was 4.8 (4.2) (range: 1-14) and 1.4 (3.3) (range: 0-16, p<0.0001), respectively. 9 (19%) patients died, at a mean of 13 (8) days after follow-up CECT (range: 1-27 days) and at a mean of 28 (16) days after admission (range: 11-68 days). 78% (7/9) of deaths were associated with progression of COVID-19 pneumonia.
Conclusion: Hospitalized patients with COVID-19 have a clinically apparent 5.7% rate of developing PE. In patients with follow-up imaging, 72.3% had radiographic thrombus resolution at a mean of 44 days while on anticoagulation. Prospective studies of the natural history of PEs with COVID-19 that include systematic follow-up imaging are warranted to help guide anticoagulation recommendations.
. 2022 Jan 24;S2213-333X(22)00002-6.
doi: 10.1016/j.jvsv.2021.12.086. Online ahead of print.
Resolution of Acute Pulmonary Embolism using anticoagulation therapy alone in Coronavirus Disease 2019
Charles A Ritchie[SUP] 1 [/SUP], Margaret M Johnson[SUP] 2 [/SUP], Justin T Stowell[SUP] 1 [/SUP], Hajra Idrees[SUP] 1 [/SUP], Beau Toskich[SUP] 1 [/SUP], Ricardo Paz-Fumagalli[SUP] 1 [/SUP], Seyed Montazeri[SUP] 1 [/SUP], Susana Fortich[SUP] 3 [/SUP], Camila Franco-Mesa[SUP] 3 [/SUP], Peter Gloviczki[SUP] 4 [/SUP], Haraldur Bjarnason[SUP] 5 [/SUP], Candido Rivera[SUP] 6 [/SUP], Marwan Shaikh[SUP] 6 [/SUP], Pablo Moreno-Franco[SUP] 7 [/SUP], Devang Sanghavi[SUP] 7 [/SUP], Christopher P Marquez[SUP] 8 [/SUP], Robert D McBane[SUP] 9 [/SUP], Myung S Park[SUP] 10 [/SUP], John C O'Horo[SUP] 11 [/SUP], James F Meschia[SUP] 12 [/SUP], Young Erben[SUP] 13 [/SUP]
Affiliations
- PMID: 35085829
- DOI: 10.1016/j.jvsv.2021.12.086
Abstract
Objective: To investigate the radiographic resolution of acute pulmonary embolism (PE) using contrast enhanced computed tomography (CECT) examinations in patients diagnosed with acute PE while hospitalized with coronavirus 2019 (COVID-19) disease and to understand the mid-term/long-term implications of anticoagulation therapy.
Methods: We identified patients with acute PE per CECT and at least one follow-up CECT from 3/11/2020 to 5/27/2021 using a prospective registry of all hospitalized patients with COVID-19 infection receiving care within a multicenter Health System. Initial and follow-up CECT examinations were reviewed independently by two radiologists to evaluate for PE resolution. The modified Miller score (MMS) was used to assess for thrombus burden at diagnosis and on follow-up.
Results: Of the 6070 hospitalized patients with COVID-19 infection, 5.7% (348/6070) were diagnosed with acute PE. 13.5% (47/348) had a follow-up CECT examination. Mean (SD) time to follow-up imaging was 44 (48) days (range: 3-161 days). 72.3% (34/47) of patients had radiographic resolution of PE, with a mean time to follow-up of 48 (43) days (range: 6-239 days). All patients received anticoagulation monotherapy for a mean of 149 (95) days and this included apixaban (63.8%), warfarin (12.8%) and rivaroxaban (8.5%) among others. The mean MMS at PE diagnosis and follow-up was 4.8 (4.2) (range: 1-14) and 1.4 (3.3) (range: 0-16, p<0.0001), respectively. 9 (19%) patients died, at a mean of 13 (8) days after follow-up CECT (range: 1-27 days) and at a mean of 28 (16) days after admission (range: 11-68 days). 78% (7/9) of deaths were associated with progression of COVID-19 pneumonia.
Conclusion: Hospitalized patients with COVID-19 have a clinically apparent 5.7% rate of developing PE. In patients with follow-up imaging, 72.3% had radiographic thrombus resolution at a mean of 44 days while on anticoagulation. Prospective studies of the natural history of PEs with COVID-19 that include systematic follow-up imaging are warranted to help guide anticoagulation recommendations.
