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CC BY 4.0 · TH Open 2021; 05(03): e387-e399
DOI: 10.1055/s-0041-1735155
Original Article

Ruling out Pulmonary Embolism in Patients with (Suspected) COVID-19—A Prospective Cohort Study

Milou A.M. Stals 
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
,
Fleur H.J. Kaptein
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
,
Remy H.H. Bemelmans
2   Department of Internal Medicine, Hospital Gelderse Vallei, Ede, Gelderland, The Netherlands
,
Thomas van Bemmel
3   Department of Internal Medicine, Gelre Ziekenhuizen Apeldoorn, Apeldoorn, Gelderland, The Netherlands
,
Inge C. Boukema
4   Department of Internal Medicine, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
,
Dionne C.W. Braeken
5   Thrombosis Expertise Center, Maastricht University Medical Center, Maastricht, Limburg, the Netherlands
,
Sander J.E. Braken
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
,
Carlinda Bresser
6   Department of Hematology, Red Cross Hospital, Beverwijk, Noord-Holland, The Netherlands
,
Hugo ten Cate
7   Thrombosis Expertise Center, Maastricht University Medical Centre + , Maastricht, Limburg, The Netherlands
,
Duco D. Deenstra
8   Department of Pulmonology, Catharina Hospital, Eindhoven, North Brabant, The Netherlands
,
Yordi P.A. van Dooren
9   Department of Pulmonology, Groene Hart Hospital, Gouda, Zuid-Holland, The Netherlands
,
Laura M. Faber
10   Department of Hematology, Red Cross Hospital, Beverwijk, Noord-Holland, The Netherlands
,
Marco J.J.H. Grootenboers
11   Department of Pulmonology, Amphia Hospital, Breda, North Brabant, The Netherlands
,
Lianne R. de Haan
12   Department of Internal Medicine, Flevo Hospital, Almere, Flevoland, The Netherlands
,
Carolien Haazer
13   Department of Internal Medicine, Reinier de Graaf Hospital, Delft, Zuid-Holland, The Netherlands
,
Antonio Iglesias del Sol
14   Department of Internal Medicine, Alrijne Hospital Location Leiderdorp, Leiderdorp, Zuid-Holland, The Netherlands
,
Sarah Kelliher
15   Department of Hematology, Mater Misericordiae University Hospital, Dublin, Ireland
,
Ted Koster
16   Department of Internal Medicine, Groene Hart Hospital, Gouda, Zuid-Holland, The Netherlands
,
Lucia J.M. Kroft
17   Department of Radiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
,
Rick I. Meijer
18   Department of Internal Medicine Amsterdam UMC Locatie VUMC, Amsterdam, Noord-Holland, The Netherlands
,
Fleur Pals
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
,
Eric R.E. van Thiel
19   Department of Pulmonology, Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, The Netherlands
,
Peter E. Westerweel
20   Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, Zuid-Holland, The Netherlands
,
Marije ten Wolde
12   Department of Internal Medicine, Flevo Hospital, Almere, Flevoland, The Netherlands
,
Frederikus A. Klok 
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
,
Menno V. Huisman
1   Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
,
on behalf of the Dutch COVID & Thrombosis Coalition (DCTC) › Author Affiliations 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.
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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.

Keywords

venous thromboembolism - diagnosis - pulmonary embolism - COVID-19

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).


Supplementary Material



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/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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