Ruling out Pulmonary Embolism in Patients with (Suspected) COVID-19—A Prospective Cohort Study

Milou A.M. Stals; Fleur H.J. Kaptein; Remy H.H. Bemelmans; Thomas van Bemmel; Inge C. Boukema; Dionne C.W. Braeken; Sander J.E. Braken; Carlinda Bresser; Hugo ten Cate; Duco D. Deenstra; Yordi P.A. van Dooren; Laura M. Faber; Marco J.J.H. Grootenboers; Lianne R. de Haan; Carolien Haazer; Antonio Iglesias del Sol; Sarah Kelliher; Ted Koster; Lucia J.M. Kroft; Rick I. Meijer; Fleur Pals; Eric R.E. van Thiel; Peter E. Westerweel; Marije ten Wolde; Frederikus A. Klok; Menno V. Huisman; on behalf of the Dutch COVID & Thrombosis Coalition (DCTC)

doi:10.1055/s-0041-1735155

TH Open, Inhaltsverzeichnis

CC BY 4.0 · TH Open 2021; 05(03): e387-e399
DOI: 10.1055/s-0041-1735155

Original Article

Ruling out Pulmonary Embolism in Patients with (Suspected) COVID-19—A Prospective Cohort Study

Autor*innen

Milou A.M. Stals

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
Fleur H.J. Kaptein

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
Remy H.H. Bemelmans

²Department of Internal Medicine, Hospital Gelderse Vallei, Ede, Gelderland, The Netherlands
Thomas van Bemmel

³Department of Internal Medicine, Gelre Ziekenhuizen Apeldoorn, Apeldoorn, Gelderland, The Netherlands
Inge C. Boukema

⁴Department of Internal Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
Dionne C.W. Braeken

⁵Thrombosis Expertise Center, Maastricht University Medical Center, Maastricht, Limburg, the Netherlands
Sander J.E. Braken

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
Carlinda Bresser

⁶Department of Hematology, Red Cross Hospital, Beverwijk, Noord-Holland, The Netherlands
Hugo ten Cate

⁷Thrombosis Expertise Center, Maastricht University Medical Centre + , Maastricht, Limburg, The Netherlands
Duco D. Deenstra

⁸Department of Pulmonology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands
Yordi P.A. van Dooren

⁹Department of Pulmonology, Groene Hart Hospital, Gouda, Zuid-Holland, The Netherlands
Laura M. Faber

¹⁰Department of Hematology, Red Cross Hospital, Beverwijk, Noord-Holland, The Netherlands
Marco J.J.H. Grootenboers

¹¹Department of Pulmonology, Amphia Hospital, Breda, North Brabant, The Netherlands
Lianne R. de Haan

¹²Department of Internal Medicine, Flevo Hospital, Almere, Flevoland, The Netherlands
Carolien Haazer

¹³Department of Internal Medicine, Reinier de Graaf Hospital, Delft, Zuid-Holland, The Netherlands
Antonio Iglesias del Sol

¹⁴Department of Internal Medicine, Alrijne Hospital Location Leiderdorp, Leiderdorp, Zuid-Holland, The Netherlands
Sarah Kelliher

¹⁵Department of Hematology, Mater Misericordiae University Hospital, Dublin, Ireland
Ted Koster

¹⁶Department of Internal Medicine, Groene Hart Hospital, Gouda, Zuid-Holland, The Netherlands
Lucia J.M. Kroft

¹⁷Department of Radiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
Rick I. Meijer

¹⁸Department of Internal Medicine Amsterdam UMC Locatie VUMC, Amsterdam, Noord-Holland, The Netherlands
Fleur Pals

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
Eric R.E. van Thiel

¹⁹Department of Pulmonology, Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, The Netherlands
Peter E. Westerweel

²⁰Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, The Netherlands
Marije ten Wolde

¹²Department of Internal Medicine, Flevo Hospital, Almere, Flevoland, The Netherlands
Frederikus A. Klok

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
Menno V. Huisman

¹Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands

on behalf of the Dutch COVID & Thrombosis Coalition (DCTC)

Abstract

Background Diagnostic strategies for suspected pulmonary embolism (PE) have not been prospectively evaluated in COVID-19 patients.

Methods Prospective, multicenter, outcome study in 707 patients with both (suspected) COVID-19 and suspected PE in 14 hospitals. Patients on chronic anticoagulant therapy were excluded. Informed consent was obtained by opt-out approach. Patients were managed by validated diagnostic strategies for suspected PE. We evaluated the safety (3-month failure rate) and efficiency (number of computed tomography pulmonary angiographies [CTPAs] avoided) of the applied strategies.

Results Overall PE prevalence was 28%. YEARS was applied in 36%, Wells rule in 4.2%, and “CTPA only” in 52%; 7.4% was not tested because of hemodynamic or respiratory instability. Within YEARS, PE was considered excluded without CTPA in 29%, of which one patient developed nonfatal PE during follow-up (failure rate 1.4%, 95% CI 0.04–7.8). One-hundred seventeen patients (46%) managed according to YEARS had a negative CTPA, of whom 10 were diagnosed with nonfatal venous thromboembolism (VTE) during follow-up (failure rate 8.8%, 95% CI 4.3–16). In patients managed by CTPA only, 66% had an initial negative CTPA, of whom eight patients were diagnosed with a nonfatal VTE during follow-up (failure rate 3.6%, 95% CI 1.6–7.0).

Conclusion Our results underline the applicability of YEARS in (suspected) COVID-19 patients with suspected PE. CTPA could be avoided in 29% of patients managed by YEARS, with a low failure rate. The failure rate after a negative CTPA, used as a sole test or within YEARS, was non-negligible and reflects the high thrombotic risk in these patients, warranting ongoing vigilance.

Keywords

venous thromboembolism - diagnosis - pulmonary embolism - COVID-19

Volltext

Referenzen

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Zusatzmaterial

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