ACUTE PULMONARY EMBOLISM IN A PATIENT WITH A NORMAL D-DIMER

ABSTRACT

SESSION TITLE COVID-19 Case Report Posters 2 SESSION TYPE Case Report Posters PRESENTED ON 10/19/2022 1245 pm - 0145 pm INTRODUCTION: Several studies on COVID-19 have helped us better understand the dynamics of this viral illness. Initially considered to be a respiratory disease, research later showed that it was the initiation of an aggressive systemic inflammatory response including a prothrombotic state. Clinicians have used inflammatory markers such as D-dimer as an indicator for underlying thrombotic state. We present the case of a pulmonary embolism (PE) despite normal D-dimer levels. CASE PRESENTATION A 73-year-old female with a past medical history of hypertension and recent hospitalization for COVID-19 pneumonia. D-dimer on initial admission was 150, patient was treated for COVID-19 pneumonia and discharged home on 2L of O2 via nasal cannula. She returned to the hospital 1 month later with complaints of palpitations. EKG on admission showed sinus tachycardia, the patient was found saturating at 98% on 2L of oxygen, unchanged from time of discharge, otherwise vitally stable. Patients’ wells score was calculated at 1.5 which pointed towards patients being low risk for PE, D-dimer measured at 645, was within normal limits when adjusted for age, indicating a low probability of VTE. Due to recent hospitalization and infection with COVID-19, CT Angiography was obtained and showed PE of the right main pulmonary artery extending into segmental right upper and lower lobe pulmonary arteries with no right ventricular strain. Patient was started on anticoagulation, and she was discharged home in stable condition. DISCUSSION: It is now well established that COVID 19 infection causes a hypercoagulable state, Initial recommendations for management of patients with Covid-19 included measurement of serial D-dimers throughout the course of illness. This recommendation has since changed. In our case, despite the rise in inflammatory marker, the age-adjusted value was within normal limits. In addition, Wells Score, which is used to predict DVT and PE, did not serve to be a reliable scoring system. CONCLUSIONS: Trending laboratory markers like D-dimers from previous admissions should be used as a valuable tool when post COVID disease is suspected. Any increase in D-dimer even if below the cutoff for age-adjusted D-dimer should be an indicator for further evaluation with imaging to rule out underlying clots. Reference #1 Logothetis CN, Weppelmann TA, Jordan A, et al. D-Dimer Testing for the Exclusion of Pulmonary Embolism Among Hospitalized Patients With COVID-19. JAMA Netw Open. 2021;4(10)e2128802. doi10.1001/jamanetworkopen.2021.28802 DISCLOSURES No relevant relationships by Kevser Akyuz No relevant relationships by Hanan Hannoodee No relevant relationships by verisha khanam No relevant relationships by Zain Kulairi No relevant relationships by DANYAL TAHERI ABKOUH