TY - JOUR
T1 - Ruling out Pulmonary Embolism in Patients with (Suspected) COVID-19-A Prospective Cohort Study
AU - Stals, Milou A M
AU - Kaptein, Fleur H J
AU - Bemelmans, Remy H H
AU - van Bemmel, Thomas
AU - Boukema, Inge C
AU - Braeken, Dionne C W
AU - Braken, Sander J E
AU - Bresser, Carlinda
AU - Cate, Hugo Ten
AU - Deenstra, Duco D
AU - Dooren, Yordi P A van
AU - Faber, Laura M
AU - Grootenboers, Marco J J H
AU - Haan, Lianne R de
AU - Haazer, Carolien
AU - Sol, Antonio Iglesias Del
AU - Kelliher, Sarah
AU - Koster, Ted
AU - Kroft, Lucia J M
AU - Meijer, Rick I
AU - Pals, Fleur
AU - van Thiel, Eric R E
AU - Westerweel, Peter E
AU - Wolde, Marije Ten
AU - Klok, Frederikus A
AU - Huisman, Menno V
AU - Dutch COVID & Thrombosis Coalition (DCTC)
PY - 2021/7
Y1 - 2021/7
N2 - 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.
AB - 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.
U2 - 10.1055/s-0041-1735155
DO - 10.1055/s-0041-1735155
M3 - Article
C2 - 34541450
SN - 2512-9465
VL - 5
SP - e387-e399
JO - TH open : companion journal to thrombosis and haemostasis
JF - TH open : companion journal to thrombosis and haemostasis
IS - 3
ER -