Pulmonary embolism and screening for concomitant proximal deep vein thrombosis in noncritically ill hospitalized patients with coronavirus disease 2019

Abstract Background The clinical characteristics of noncritically ill patients with coronavirus disease 2019 (COVID-19) who develop pulmonary embolism (PE) and the prevalence of concomitant proximal deep-vein thrombosis (DVT) of the lower limbs have not been evaluated consistently.Methods We identified nonintensive care unit (non-ICU) patients admitted with COVID-19 who were diagnosed with PE at a single center in northwest Spain. Point-of-care compression ultrasonography (CUS) of the lower limbs was performed to screen for concomitant proximal DVT. Clinical data were analyzed retrospectively.Results From April 2 to April 17, 2020, 8 patients with COVID-19 and PE were identified. PE was diagnosed a median of 19 (interquartile range [IQR], 17–23) days after onset of COVID-19 symptoms and a median of 13 (IQR, 8–15) days after admission. All patients received thromboprophylaxis with enoxaparin or biosimilar at a median dose of 40 mg. All tested patients had high levels of D-dimer (≥2000 ng/mL), serum ferritin (≥300 mg/dL) and IL-6 (≥5 pg/mL) at PE diagnosis. Six (75%) and 7 (87.5%) patients had high C-reactive-protein (≥1 mg/dL) and lactate dehydrogenase (≥250 U/L) levels, respectively. All PE events were segmental or subsegmental, with lobar involvement in only one. None of these patients had concomitant proximal DVT of the lower limbs on CUS.Conclusions Non-ICU hospitalized patients with COVID-19 diagnosed with PE had mainly segmental or subsegmental events without concomitant proximal DVT of the lower limbs. Our findings suggest a predominance of small-vessel thrombosis secondary to inflammatory and immune responses in these patients.