Clinical and computed tomography characteristics of COVID-19 associated acute pulmonary embolism: A different phenotype of thrombotic disease?

被引:136
作者
van Dam, L. F. [1 ]
Kroft, L. J. M. [2 ]
van der Wal, L. I. [3 ]
Cannegieter, S. C. [1 ,4 ]
Eikenboom, J. [1 ]
de Jonge, E. [3 ]
Huisman, M. V. [1 ]
Klok, F. A. [1 ]
机构
[1] Leiden Univ, Med Ctr, Dept Thrombosis & Hemostasis, Albinusdreef 2, NL-2300 RC Leiden, Netherlands
[2] Leiden Univ, Med Ctr, Dept Radiol, Leiden, Netherlands
[3] Leiden Univ, Med Ctr, Dept Intens Care Med, Leiden, Netherlands
[4] Leiden Univ, Med Ctr, Dept Clin Epidemiol, Leiden, Netherlands
关键词
Pulmonary embolism; COVID-19; Computed tomography; Thrombosis;
D O I
10.1016/j.thromres.2020.06.010
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: COVID-19 infections are associated with a high prevalence of venous thromboembolism, particularly pulmonary embolism (PE). It is suggested that COVID-19 associated PE represents in situ immunothrombosis rather than venous thromboembolism, although the origin of thrombotic lesions in COVID-19 patients remains largely unknown. Methods: In this study, we assessed the clinical and computed tomography (CT) characteristics of PE in 23 consecutive patients with COVID-19 pneumonia and compared these to those of 100 consecutive control patients diagnosed with acute PE before the COVID-19 outbreak. Specifically, RV/LV diameter ratio, pulmonary artery trunk diameter and total thrombus load (according to Qanadli score) were measured and compared. Results: We observed that all thrombotic lesions in COVID-19 patients were found to be in lung parenchyma affected by COVID-19. Also, the thrombus load was lower in COVID-19 patients (Qanadli score -8%, 95% confidence interval [95%CI] -16 to -0.36%) as was the prevalence of the most proximal PE in the main/lobar pulmonary artery (17% versus 47%; -30%, 95%CI -44% to -8.2). Moreover, the mean RV/LV ratio (mean difference -0.23, 95%CI -0.39 to -0.07) and the prevalence of RV/LV ratio > 1.0 (prevalence difference -23%, 95%CI -41 to -0.86%) were lower in the COVID-19 patients. Conclusion: Our findings therefore suggest that the phenotype of COVID-19 associated PE indeed differs from PE in patients without COVID-19, fuelling the discussion on its pathophysiology.
引用
收藏
页码:86 / 89
页数:4
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