Pulmonary emboli and COVID-19: an increased risk for all?

Abstract

<bold>Introduction:</bold> The pro-thrombotic nature of critically unwell patients with severe COVID-19 has been well established (Helms J et al. Intensive Care Medicine 2020; 46:1089-1098); however less well documented is the association with non-severe cases of COVID-19. We hypothesised that the increased incidence in pulmonary embolism (PE) we observed during the early phase of the pandemic could be due to thrombogenicity related to non-severe COVID-19 disease. <bold>Methods:</bold> All CT Pulmonary Angiograms (CTPAs) performed during a 7-week period in May-June 2020 and a historical cohort from the same time period in 2019, in one university teaching hospital, were screened for PE. Characteristics including presenting symptomatology, COVID-19 status and PE risk-stratification were gathered via electronic medical records. <bold>Results:</bold> 240 CTPAs were performed during the 2020 study period, and 263 during the 2019 equivalent. In 2019, 18% of CTPAs were positive for PE, compared to 25% in 2020 - 35% of CTPAs in patients categorised as highly-suspicious or confirmed COVID-19 and 20% of CTPAs in patients not suspected to have COVID-19. Radiological evidence of right heart strain was present in 42% of patients in 2020 and 15% in 2019. Syncope and ‘sub-acute breathlessness’ were more common presenting symptoms in 2020 compared to 2019. <bold>Conclusions:</bold> Our data is suggestive of a COVID-induced pro-thrombotic state which appears to be present even in those with mild-moderate disease. Our findings support a higher risk profile in those presenting with PE during the COVID pandemic and the presenting symptomatology suggests a need to recognise persistent, sub-acute breathlessness as a potential symptom of PE, rather than attributing it to uncomplicated COVID-19 recovery.