Niculae Cristian-Mihail, Anghel Ana-Maria-Jennifer, Militaru Eliza-Daniela, Tîrlescu Laura-Georgiana, Lazar Mihai, Hristea Adriana
Infectious Diseases Department, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", No. 37, Dionisie Lupu Street, Sector 2, 020021 Bucharest, Romania.
National Institute for Infectious Diseases "Prof. Dr. Matei Bals", No. 1, Calistrat Grozovici Street, Sector 2, 021105 Bucharest, Romania.
J Clin Med. 2022 May 7;11(9):2633. doi: 10.3390/jcm11092633.
(1) Background: We aimed to describe the clinical and imaging characteristics of patients diagnosed with pulmonary artery thrombosis (PAT) despite receiving anticoagulation with low-molecular-weight heparin (LMWH). (2) Methods: We retrospectively studied all hospitalized COVID-19 adult patients diagnosed with PAT between March 2020 and December 2021, who received LMWH for ≥72 h until the diagnosis of PAT. Acute PAT was confirmed by a CT pulmonary angiogram. (3) Results: We included 30 severe and critical COVID-19 patients. Median age was 62 (54-74) years, with 83.3% males, and comorbidities seen in 73.3%. PAT was diagnosed despite prophylactic (23.3%), intermediate (46.6%) or therapeutic (30%) doses of LMWH for a median time of 8 (4.7-12) days. According to their Wells score, 80% of patients had a low probability of pulmonary embolism diagnosis. PAT was localized in the lower lobes of the lungs in 76.6% of cases with 33.3% having bilateral involvement, with the distal, peripheral arteries being the most affected. At the PAT diagnosis we found a worsening of respiratory function, with seven patients progressing to mechanical ventilation ( = 0.006). The in-hospital mortality was 30%. (4) Conclusions: PAT should be considered in patients with severe and critical COVID-19, mainly in elderly male patients with comorbidities, irrespective of Wells score and LMWH anticoagulation.
(1) 背景：我们旨在描述尽管接受了低分子量肝素（LMWH）抗凝治疗，但仍被诊断为肺动脉血栓形成（PAT）的患者的临床和影像学特征。(2) 方法：我们回顾性研究了2020年3月至2021年12月期间所有住院的成年COVID-19患者，这些患者被诊断为PAT，且接受LMWH治疗≥72小时直至PAT确诊。通过CT肺动脉造影确诊急性PAT。(3) 结果：我们纳入了30例重症和危重症COVID-19患者。中位年龄为62（54 - 74）岁，男性占83.3%，73.3%的患者有合并症。尽管接受了预防性（23.3%）、中等剂量（46.6%）或治疗性（30%）的LMWH，中位时间为8（4.7 - 12）天，但仍诊断出PAT。根据Wells评分，80%的患者肺栓塞诊断可能性较低。76.6%的病例中PAT位于肺下叶，33.3%为双侧受累，远端外周动脉受累最为常见。在PAT诊断时，我们发现呼吸功能恶化，7例患者进展为机械通气（P = 0.006）。住院死亡率为30%。(4) 结论：对于重症和危重症COVID-19患者，应考虑PAT，主要是患有合并症的老年男性患者，无论Wells评分和LMWH抗凝情况如何。
