Gatto Maria Chiara, Oliva Alessandra, Palazzolo Claudia, Picariello Claudio, Garascia Andrea, Nicastri Emanuele, Girardi Enrico, Antinori Andrea
National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, Via Portuense, 292, 00149 Rome, Italy.
Department of Public Health and Infectious Disease, Sapienza University of Rome, Piazzale Aldo Moro n.5, 00185 Rome, Italy.
Biomedicines. 2023 Apr 26;11(5):1282. doi: 10.3390/biomedicines11051282.
Pulmonary embolism (PE) has been associated with SARS-CoV-2 infection, and its incidence is highly variable. The aim of our study was to describe the radiological and clinical presentations, as well as the therapeutic management, of PEs that occurred during SARS-CoV-2 infection in a cohort of hospitalized patients. In this observational study, we enrolled patients with moderate COVID-19 who developed PE during hospitalization. Clinical, laboratory, and radiological features were recorded. PE was diagnosed on clinical suspicion and/or CT angiography. According to CT angiography results, two groups of patients were further distinguished: those with proximal or central pulmonary embolism (cPE) and those with distal or micro-pulmonary embolism (mPE). A total of 56 patients with a mean age of 78 ± 15 years were included. Overall, PE occurred after a median of 2 days from hospitalization (range 0-47 days) and, interestingly, the majority of them (89%) within the first 10 days of hospitalization, without differences between the groups. Patients with cPE were younger ( = 0.02), with a lower creatinine clearance ( = 0.04), and tended to have a higher body weight ( = 0.059) and higher D-Dimer values ( = 0.059) than patients with mPE. In all patients, low-weight molecular heparin (LWMH) at anticoagulant dosage was promptly started as soon as PE was diagnosed. After a mean of 16 ± 9 days, 94% of patients with cPE were switched to oral anticoagulant (OAC) therapy, which was a direct oral anticoagulant (DOAC) in 86% of cases. In contrast, only in 68% of patients with mPE, the prosecution with OAC was indicated. The duration of treatment was at least 3 months from PE diagnosis in all patients who started OAC. At the 3-month follow-up, no persistence or recurrence of PE as well as no clinically relevant bleedings were found in both groups. In conclusion, pulmonary embolism in patients with SARS-CoV-2 may have different extensions. Used with clinical judgment, oral anticoagulant therapy with DOAC was effective and safe.
肺栓塞（PE）与新型冠状病毒肺炎（SARS-CoV-2）感染有关，其发病率差异很大。我们研究的目的是描述一组住院患者在SARS-CoV-2感染期间发生的PE的影像学和临床表现以及治疗管理。在这项观察性研究中，我们纳入了在住院期间发生PE的中度新型冠状病毒肺炎（COVID-19）患者。记录临床、实验室和影像学特征。根据临床怀疑和/或CT血管造影诊断PE。根据CT血管造影结果，进一步区分两组患者：近端或中心性肺栓塞（cPE）患者和远端或微肺栓塞（mPE）患者。共纳入56例平均年龄为78±15岁的患者。总体而言，PE发生在住院中位数2天后（范围0-47天），有趣的是，其中大多数（89%）发生在住院的前10天内，两组之间无差异。与mPE患者相比，cPE患者更年轻（P = 0.02），肌酐清除率更低（P = 0.04），且体重往往更高（P = 0.059），D-二聚体值更高（P = 0.059）。在所有患者中，一旦诊断出PE，立即开始使用抗凝剂量的低分子量肝素（LWMH）。平均16±9天后，94%的cPE患者转为口服抗凝剂（OAC）治疗，其中86%的病例使用直接口服抗凝剂（DOAC）。相比之下，只有68%的mPE患者需要继续使用OAC。所有开始使用OAC的患者，治疗持续时间至少为PE诊断后3个月。在3个月的随访中，两组均未发现PE持续存在或复发以及临床相关出血。总之，SARS-CoV-2患者的肺栓塞可能有不同的范围。结合临床判断使用，DOAC口服抗凝治疗有效且安全。
