학술논문
Ruling out Pulmonary Embolism in Patients with (Suspected) COVID-19—A Prospective Cohort Study
Document Type
article
Author
Milou A.M. Stals; Fleur H.J. Kaptein; Remy H.H. Bemelmans; Thomas van Bemmel; Inge C. Boukema; Dionne C.W. Braeken; Sander J.E. Braken; Carlinda Bresser; Hugo ten Cate; Duco D. Deenstra; Yordi P.A. van Dooren; Laura M. Faber; Marco J.J.H. Grootenboers; Lianne R. de Haan; Carolien Haazer; Antonio Iglesias del Sol; Sarah Kelliher; Ted Koster; Lucia J.M. Kroft; Rick I. Meijer; Fleur Pals; Eric R.E. van Thiel; Peter E. Westerweel; Marije ten Wolde; Frederikus A. Klok; Menno V. Huisman
Source
TH Open, Vol 05, Iss 03, Pp e387-e399 (2021)
Subject
Language
English
ISSN
2512-9465
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.