Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review
Abstract Background Preliminary reports have described significant procoagulant events in patients with coronavirus disease-2019 (COVID-19), including life-threatening pulmonary embolism (PE). Main text We review the current data on the epidemiology, the possible underlying pathophysiologic mechanis...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-09-01
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| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13613-020-00741-0 |
| _version_ | 1819013167887417344 |
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| author | Yasser Sakr Manuela Giovini Marc Leone Giacinto Pizzilli Andreas Kortgen Michael Bauer Tommaso Tonetti Gary Duclos Laurent Zieleskiewicz Samuel Buschbeck V. Marco Ranieri Elio Antonucci |
| author_facet | Yasser Sakr Manuela Giovini Marc Leone Giacinto Pizzilli Andreas Kortgen Michael Bauer Tommaso Tonetti Gary Duclos Laurent Zieleskiewicz Samuel Buschbeck V. Marco Ranieri Elio Antonucci |
| author_sort | Yasser Sakr |
| collection | DOAJ |
| description | Abstract Background Preliminary reports have described significant procoagulant events in patients with coronavirus disease-2019 (COVID-19), including life-threatening pulmonary embolism (PE). Main text We review the current data on the epidemiology, the possible underlying pathophysiologic mechanisms, and the therapeutic implications of PE in relation to COVID-19. The incidence of PE is reported to be around 2.6–8.9% of COVID-19 in hospitalized patients and up to one-third of those requiring intensive care unit (ICU) admission, despite standard prophylactic anticoagulation. This may be explained by direct and indirect pathologic consequences of COVID-19, complement activation, cytokine release, endothelial dysfunction, and interactions between different types of blood cells. Conclusion Thromboprophylaxis should be started in all patients with suspected or confirmed COVID-19 admitted to the hospital. The use of an intermediate therapeutic dose of low molecular weight (LMWH) or unfractionated heparin can be considered on an individual basis in patients with multiple risk factors for venous thromboembolism, including critically ill patients admitted to the ICU. Decisions about extending prophylaxis with LMWH after hospital discharge should be made after balancing the reduced risk of venous thromboembolism (VTE) with the risk of increased bleeding events and should be continued for 7–14 days after hospital discharge or in the pre-hospital phase in case of pre-existing or persisting VTE risk factors. Therapeutic anticoagulation is the cornerstone in the management of patients with PE. Selection of an appropriate agent and correct dosing requires consideration of underlying comorbidities. |
| first_indexed | 2024-12-21T01:55:39Z |
| format | Article |
| id | doaj.art-21e1998938694b45b1b39d5a6c2b112e |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-21T01:55:39Z |
| publishDate | 2020-09-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-21e1998938694b45b1b39d5a6c2b112e2022-12-21T19:19:46ZengSpringerOpenAnnals of Intensive Care2110-58202020-09-0110111310.1186/s13613-020-00741-0Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative reviewYasser Sakr0Manuela Giovini1Marc Leone2Giacinto Pizzilli3Andreas Kortgen4Michael Bauer5Tommaso Tonetti6Gary Duclos7Laurent Zieleskiewicz8Samuel Buschbeck9V. Marco Ranieri10Elio Antonucci11Dept. of Anesthesiology and Intensive Care Medicine, Jena University HospitalIntermediate Care Unit, Emergency Department, Ospedale Guglielmo da SalicetoService d’Anesthésie et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital NordDipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Alma Mater Studiorum, Università di Bologna, Policlinico di Sant’OrsolaDept. of Anesthesiology and Intensive Care Medicine, Jena University HospitalDept. of Anesthesiology and Intensive Care Medicine, Jena University HospitalDipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Alma Mater Studiorum, Università di Bologna, Policlinico di Sant’OrsolaService d’Anesthésie et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital NordService d’Anesthésie et de Réanimation, Aix Marseille Université, Assistance Publique Hôpitaux Universitaires de Marseille, Hôpital NordDept. of Anesthesiology and Intensive Care Medicine, Jena University HospitalDipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Alma Mater Studiorum, Università di Bologna, Policlinico di Sant’OrsolaIntermediate Care Unit, Emergency Department, Ospedale Guglielmo da SalicetoAbstract Background Preliminary reports have described significant procoagulant events in patients with coronavirus disease-2019 (COVID-19), including life-threatening pulmonary embolism (PE). Main text We review the current data on the epidemiology, the possible underlying pathophysiologic mechanisms, and the therapeutic implications of PE in relation to COVID-19. The incidence of PE is reported to be around 2.6–8.9% of COVID-19 in hospitalized patients and up to one-third of those requiring intensive care unit (ICU) admission, despite standard prophylactic anticoagulation. This may be explained by direct and indirect pathologic consequences of COVID-19, complement activation, cytokine release, endothelial dysfunction, and interactions between different types of blood cells. Conclusion Thromboprophylaxis should be started in all patients with suspected or confirmed COVID-19 admitted to the hospital. The use of an intermediate therapeutic dose of low molecular weight (LMWH) or unfractionated heparin can be considered on an individual basis in patients with multiple risk factors for venous thromboembolism, including critically ill patients admitted to the ICU. Decisions about extending prophylaxis with LMWH after hospital discharge should be made after balancing the reduced risk of venous thromboembolism (VTE) with the risk of increased bleeding events and should be continued for 7–14 days after hospital discharge or in the pre-hospital phase in case of pre-existing or persisting VTE risk factors. Therapeutic anticoagulation is the cornerstone in the management of patients with PE. Selection of an appropriate agent and correct dosing requires consideration of underlying comorbidities.http://link.springer.com/article/10.1186/s13613-020-00741-0SARS-CoV-2COVID-19Pulmonary embolismThromboprophylaxisVenous thromboembolism |
| spellingShingle | Yasser Sakr Manuela Giovini Marc Leone Giacinto Pizzilli Andreas Kortgen Michael Bauer Tommaso Tonetti Gary Duclos Laurent Zieleskiewicz Samuel Buschbeck V. Marco Ranieri Elio Antonucci Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review Annals of Intensive Care SARS-CoV-2 COVID-19 Pulmonary embolism Thromboprophylaxis Venous thromboembolism |
| title | Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review |
| title_full | Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review |
| title_fullStr | Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review |
| title_full_unstemmed | Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review |
| title_short | Pulmonary embolism in patients with coronavirus disease-2019 (COVID-19) pneumonia: a narrative review |
| title_sort | pulmonary embolism in patients with coronavirus disease 2019 covid 19 pneumonia a narrative review |
| topic | SARS-CoV-2 COVID-19 Pulmonary embolism Thromboprophylaxis Venous thromboembolism |
| url | http://link.springer.com/article/10.1186/s13613-020-00741-0 |
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