Rate of Pulmonary Thromboembolism in the Ongoing Symptomatic COVID-19 Patients

Introduction: Coronavirus disease 2019 (COVID-19) pandemic, which began in December 2019, is associated with high transmission and mortality rates. It is now known that COVID-19 increases the risk of venous thromboembolism due to microvascular inflammation. We aimed to explore the rate of pulmonary thromboembolism (PTE) in ongoing symptomatic COVID-19 patients and the association between D-dimer levels and PTE.

Methods: A total of 2020 patients were retrospectively screened. Of these, 332 eligible patients over 18 years of age with a laboratory-confirmed diagnosis of COVID-19 and who underwent pulmonary computed tomography (CT) angiography due to suspected PTE 14–90 days after COVID-19 positivity were included. Over 500 μg/L was considered abnormally high for D-dimer.

Results: The mean age was 57 years, and 55.4% (n=184) were females. Of the total patients, 58 patients had PTE. Males were found to have a significantly higher risk for PTE (M/F: 33/25). A significant relationship between advanced age and PTE risk was observed as well. PTE occurred mostly in the segmental arteries in 10.8%. The use of low-molecu-lar-weight heparin was not associated with a significant preventive effect for PTE. In a multivariate logistic regression analysis of independent variables, including age, gender, D-dimer level, and timing of pulmonary CT angiography, D-dimer level was found to have the highest predictive value for PTE. The sensitivity and negative predictive value for a cutoff of 745 μg/L were 89.7% (78.8–96.1) and 93.4% (86.7–96.9), respectively.

Discussion and Conclusion: PTE continues to pose a serious risk in these patients, and it remains unclear who was at risk for PTE.

Keywords: D-dimer; Ongoing COVID-19; Pulmonary thromboembolism