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DOI: 10.1055/s-0041-1735155
Ruling out Pulmonary Embolism in Patients with (Suspected) COVID-19—A Prospective Cohort Study
Funding The Dutch COVID and Thrombosis Coalition was funded by the Netherlands Thrombosis Foundation: Grant/Award Number: 2020_A and the Netherlands Organization for Health Research and Development: Grant/Award Number: 10430012010004.![](https://www.thieme-connect.de/media/10.1055-s-00033990/202103/lookinside/thumbnails/10-1055-s-0041-1735155_210051-1.jpg)
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.
Authors' Contribution
See [Supplementary Appendix B].
Data Sharing
Anonymous data on patients as collected in this study can be made available to others, on request to the corresponding author of this manuscript (M.V.H.). The request will be granted after approval of a methodologically sound proposal and a signed data sharing agreement is required. Data will be available after publication of the article and until 5 years following article publication.
* Appendix A Dutch COVID & Thrombosis Coalition (DCTC).
Publication History
Received: 08 June 2021
Accepted: 07 July 2021
Article published online:
15 September 2021
© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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