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Pulmonary embolism or thrombosis in ARDS COVID-19 patients: A French monocenter retrospective study.
Contou, Damien; Pajot, Olivier; Cally, Radj; Logre, Elsa; Fraissé, Megan; Mentec, Hervé; Plantefève, Gaëtan.
  • Contou D; Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.
  • Pajot O; Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.
  • Cally R; Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.
  • Logre E; Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.
  • Fraissé M; Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.
  • Mentec H; Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.
  • Plantefève G; Service de réanimation polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.
PLoS One ; 15(8): e0238413, 2020.
Article in English | MEDLINE | ID: covidwho-732993
ABSTRACT
Hypercoagulability and endotheliopathy reported in patients with coronavirus disease 2019 (COVID-19) combined with strict and prolonged immobilization inherent to deep sedation and administration of neuromuscular blockers for Acute Respiratory Distress Syndrome (ARDS) may expose critically ill COVID-19 patients to an increased risk of venous thrombosis and pulmonary embolism (PE). We aimed to assess the rate and to describe the clinical features and the outcomes of ARDS COVID-19 patients diagnosed with PE during ICU stay. From March 13th to April 24th 2020, a total of 92 patients (median age 61 years, 1st-3rd quartiles [55-70]; males n = 73/92, 79%; baseline SOFA 4 [3-7] and SAPS II 31 [21-40]; invasive mechanical ventilation n = 83/92, 90%; ICU mortality n = 45/92, 49%) were admitted to our 41-bed COVID-19 ICU for ARDS due to COVID-19. Among them, 26 patients (n = 26/92, 28%) underwent a Computed Tomography Pulmonary Angiography which revealed PE in 16 (n = 16/26, 62%) of them, accounting for 17% (n = 16/92) of the whole cohort. PE was bilateral in 3 (19%) patients and unilateral in 13 (81%) patients. The most proximal thrombus was localized in main (n = 4, 25%), lobar (n = 2, 12%) or segmental (n = 10, 63%) pulmonary artery. Most of the thrombi (n = 13/16, 81%) were located in a parenchymatous condensation. Only three of the 16 patients (19%) had lower limb venous thrombosis on Doppler ultrasound. Three patients were treated with alteplase and anticoagulation (n = 3/16, 19%) while the 13 others (n = 13/16, 81%) were treated with anticoagulation alone. ICU mortality was higher in patients with PE compared to that of patients without PE (n = 11/16, 69% vs. n = 2/10, 20%; p = 0.04). The low rate of lower limb venous thrombosis together with the high rate of distal pulmonary thrombus argue for a local immuno-thrombotic process associated with the classic embolic process. Further larger studies are needed to assess the real prevalence and the risk factors of pulmonary embolism/thrombosis together with its prognostic impact on critically ill patients with COVID-19.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Pulmonary Embolism / Respiratory Distress Syndrome / Thrombosis / Coronavirus Infections Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2020 Document Type: Article Affiliation country: Journal.pone.0238413

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Pulmonary Embolism / Respiratory Distress Syndrome / Thrombosis / Coronavirus Infections Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2020 Document Type: Article Affiliation country: Journal.pone.0238413