ABSTRACT
Background: COVID-19 is associated with the development of life-threatening prothrombotic events, including pulmonary emboli (PE), for which the gold standard investigation is a CTPA. Aim(s): To assess the incidence of PE in our local high-dependency and ward-based COVID-19 ward and identify common indications for CTPA. Method(s): Data was collected retrospectively from inpatients admitted to our COVID-19 ward between August 1st to October 31st, 2021. Patient demographics, D-dimer values, oxygen requirements, and CTPA request indications and findings were analysed. Result(s): From a total of N=123 patients, N=45 (36.9%) had a CTPA, and N=4 (3.3% of all patients, 8.9% of CTPA requests) were positive for PE. N=44 (97.8%) CTPAs were requested to rule out a PE, with the main indications being a raised D-dimer (26.7%), hypotension (24.4%), persistent oxygen requirement (22.2%), and desaturation (22.2%). N=18 (40%) required non-invasive ventilation (NIV) at the time of CTPA request. The median time spent on therapeutic anticoagulation before a CTPA was 6 days (IQR 9). N=8 (17.7%) had bleeding complications from therapeutic anticoagulation. Conclusion(s): Our 3.3% incidence of PE is lower than the 11.7% average in a recent meta-analysis of ITU patients, consistent with studies showing that those with more severe COVID-19 have a higher incidence of PE (Tan, B.K. et al. Thorax 2021;76: 970-979). Our study was limited, as our patients could not have a CTPA whilst on NIV. They remained on therapeutic anticoagulation during this time, leading to potential false-negative results. Further studies are needed to estimate the incidence of PE and optimum duration of thromboprophylaxis in non-severe COVID-19 cases.