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

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 MeijerFleur Pals, Eric R E van Thiel, Peter E Westerweel, Marije Ten Wolde, Frederikus A Klok, Menno V Huisman, Dutch COVID & Thrombosis Coalition (DCTC)

Research output: Contribution to journalArticleAcademicpeer-review

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.

Original languageEnglish
Pages (from-to)e387-e399
JournalTH open : companion journal to thrombosis and haemostasis
Volume5
Issue number3
DOIs
Publication statusPublished - Jul 2021

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