ABSTRACT
Coronavirus disease (COVID-19) pandemic is an unprecedented public health calamity that has caused an immense setback to maternal health services in developing countries. In addition to morbidity and mortality caused by COVID-19 disease in parturient directly, the indirect adverse impact of lockdown imposed during pandemic causing loss of follow-up of patients with coexisting illness is significant. There are no standard protocols to manage COVID-19 patients with comorbid medical illness, who are not optimized during antenatal visits. We report an interesting case of an antenatal patient with COVID-19, with prosthetic aortic valve on warfarin with elevated International Normalized Ratio (INR) and severe pre-eclampsia, posted for emergency cesarean section.
ABSTRACT
Purpose: Emerging reports have shown an increased incidence of pulmonary embolism (PE) in hospitalized COVID-19 patients which subsequently worsens respiratory distress and can lead to further clinical deterioration. We sought to determine whether PE in Corona virus patients were more likely thrombotic or embolic in etiology, and the role of IVC filters in hospitalized COVID-19 patients. Materials and Methods: A single-center retrospective analysis evaluating all CT pulmonary angiograms (684) that were completed at the height of the COVID-19 pandemic between March 15, 2020, and May 31, 2020, at a tertiary care center in an urban setting. Deep venous thrombosis (DVT) was defined as iliocaval or femoropopliteal thrombus on lower extremity Doppler or CT with lower extremity runoff, or brachial, axillary, subclavian, or internal jugular vein thrombus on upper extremity Doppler. PE was considered thrombotic in patients in the absence of DVT and embolic in the presence of DVT during their inpatient stay. COVID-19 status was based on the most recent results prior to the patient’s CT pulmonary angiogram, if testing was not conducted, the patient was considered negative for COVID-19. Chi-square analysis was carried out to determine the difference in rates between thrombotic versus embolic PE in Corona virus positive and negative patients. Results: Imaging confirmed acute PE in 112 patients during this period, of which 43 (38%) tested positive for COVID-19, and 69 (62%) tested negative. Of patients testing positive for Corona virus with PE, imaging confirmed concurrent lower or upper extremity DVT in 4 of 43 patients (9%) and ruled out DVT in 24 of 43 patients (56%). Whereas, in COVID-19 negative patients with PE, imaging confirmation of DVT was seen in 19 of 69 patients (28%) and DVT was ruled out in 21 of 69 patients (30%). This correlated with a chi-square value of 8.12 (P = 0.004). Conclusions: Pulmonary emboli in COVID-19 patients are more likely to be thrombotic rather than embolic in etiology, limiting the utility of IVC filters in Corona virus patients.