Ruling out Pulmonary Embolism in Patients with (Suspected) COVID-19—A Prospective Cohort Study

Abstract Background  Diagnostic strategies for suspected pulmonary embolism (PE) have not been prospectively evaluated in COVID-19 patients. Methods  Prospective, multicenter, outcome study in 707 patients with both (suspected) COVID-19 and suspected PE in 14 hospitals. Patients on chronic anticoagu...

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Published inTH open : companion journal to thrombosis and haemostasis Vol. 5; no. 3; pp. e387 - e399
Main Authors Stals, Milou A.M., Kaptein, Fleur H.J., Bemelmans, Remy H.H., van Bemmel, Thomas, Boukema, Inge C., Braeken, Dionne C.W., Braken, Sander J.E., Bresser, Carlinda, Cate, Hugo ten, Deenstra, Duco D., Dooren, Yordi P.A. van, Faber, Laura M., Grootenboers, Marco J.J.H., Haan, Lianne R. de, Haazer, Carolien, Sol, Antonio Iglesias del, Kelliher, Sarah, Koster, Ted, Kroft, Lucia J.M., Meijer, Rick I., Pals, Fleur, van Thiel, Eric R.E., Westerweel, Peter E., Wolde, Marije ten, Klok, Frederikus A., Huisman, Menno V.
Format Journal Article
LanguageEnglish
Published Rüdigerstraße 14, 70469 Stuttgart, Germany Georg Thieme Verlag KG 01.07.2021
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Summary:Abstract Background  Diagnostic strategies for suspected pulmonary embolism (PE) have not been prospectively evaluated in COVID-19 patients. Methods  Prospective, multicenter, outcome study in 707 patients with both (suspected) COVID-19 and suspected PE in 14 hospitals. Patients on chronic anticoagulant therapy were excluded. Informed consent was obtained by opt-out approach. Patients were managed by validated diagnostic strategies for suspected PE. We evaluated the safety (3-month failure rate) and efficiency (number of computed tomography pulmonary angiographies [CTPAs] avoided) of the applied strategies. Results  Overall PE prevalence was 28%. YEARS was applied in 36%, Wells rule in 4.2%, and “CTPA only” in 52%; 7.4% was not tested because of hemodynamic or respiratory instability. Within YEARS, PE was considered excluded without CTPA in 29%, of which one patient developed nonfatal PE during follow-up (failure rate 1.4%, 95% CI 0.04–7.8). One-hundred seventeen patients (46%) managed according to YEARS had a negative CTPA, of whom 10 were diagnosed with nonfatal venous thromboembolism (VTE) during follow-up (failure rate 8.8%, 95% CI 4.3–16). In patients managed by CTPA only, 66% had an initial negative CTPA, of whom eight patients were diagnosed with a nonfatal VTE during follow-up (failure rate 3.6%, 95% CI 1.6–7.0). Conclusion  Our results underline the applicability of YEARS in (suspected) COVID-19 patients with suspected PE. CTPA could be avoided in 29% of patients managed by YEARS, with a low failure rate. The failure rate after a negative CTPA, used as a sole test or within YEARS, was non-negligible and reflects the high thrombotic risk in these patients, warranting ongoing vigilance.
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ISSN:2512-9465
2567-3459
2512-9465
DOI:10.1055/s-0041-1735155