Abstract
Summary: COVID-19 is a recently identified illness that is associated with thromboembolic events. We report a case of pulmonary embolism in a patient with COVID-19, treated by catheter directed thrombectomy. A 57 year old patient presented to the emergency center with severe COVID-19 symptoms and developed massive pulmonary embolism. The patient was treated with catheter directed thrombolysis (CDT) and recovered completely. Coagulopathy associated with COVID-19 is present in all severe cases and is a dynamic process. We describe a case of massive/high risk pulmonary embolism, in a patient with COVID-19 receiving full anticoagulation, who was treated by percutaneous intervention. CDT can be an additional therapeutic option in patients with COVID-19 and pulmonary embolism that present with rapid clinical collapse.
References
1 . Director-General’s remarks at the media briefing on 2019-nCoV on 11 February 2020. Coronavirus-Covid-19. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020
2 The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status. Mil Med Res. 2020;7(1):1–10.
3 . Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases from the Chinese Center for Disease Control and Prevention. JAMA – J Am Med Assoc. 2020;2019:3–6.
4 . Johns Hopkins University & Medicine Coronavirus Resource Center. Retrieved April 3rd, 2020 from https://coronavirus.jhu.edu/map.html
5 Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med. 2020. [Ahead of publication]. https://doi.org/10.1515/cclm-2020-0188
6 . Vital surveillances: the epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) – China, 2020. China CDC Weekly. Retrieved April 3rd, 2020 from http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51
7 . Use of in situ simulation to evaluate the operational readiness of a high-consequence infectious disease intensive care unit. Anaesthesia [Internet]. 2020;1–6. https://doi.org/10.1111/anae.15048
8 . Characteristics, causes, diagnosis and treatment of coagulation dysfunction in patients with COVID-19. Zhonghua Xue Ye Xue Za Zhi. 2020;41(00):E002. https://doi.org/10.3760/cma.j.issn.0253-2727.2020.0002
9 Risk assessment of venous thromboembolism and bleeding in COVID-19 patients. Res Sqause [Preprint]. https://doi.org/10.21203/rs.3.rs-18340/v1
10 . Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844–7.
11 VTE incidence and risk factors in patients with severe sepsis and septic shock. Chest. 2015;148(5):1224–1230. https://doi.org/10.1378/chest.15-0287
12 . Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18(5):1094–9.
13 Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020;191:9–14.
14 Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020. In press. Available from: https://doi.org/10.1016/j.thromres.2020.04.013
15 Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: A scientific statement from the american heart association. Circulation. 2011;123(16):1788–830.
16 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS). Eur Heart J. 2020;41(4):543–603.
17 . COVID-19 Complicated by acute pulmonary embolism. Radiol Cardiothorac Imaging [Internet]. 2020;2(2):e200067. Available from: http://pubs.rsna.org/doi/10.1148/ryct.2020200067
18 A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: The Padua Prediction Score. J Thromb Haemost. 2010;8(11):2450–7.
19 Factors at admission associated with bleeding risk in medical patients: Findings from the improve investigators. Chest. 2011;139(1):69–79.
20 . Acute thrombotic vascular events complicating influenza-associated pneumonia. Respir Med Case Reports [Internet]. 2019;28:100884. Available from: https://doi.org/10.1016/j.rmcr.2019.100884
21 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS). Eur Heart J. 2020;41(4):543–603.
22 . Endovascular Treatment of a Haemodynamically Unstable Massive Pulmonary Embolism using Fibrinolysis and Fragmentation. Experience with 111 Patients in a Single Centre. Why don’t we follow ACCP Recommendations? Arch Bronconeumol [Internet]. 2011;47(1):17–24. https://doi.org/10.1016/S1579-2129(11)70004-0
23 . Percutaneous pulmonary embolism thrombectomy and thrombolysis: technical tips and tricks. Semin Intervent Radiol. 2018;35(2):129–35.
24 . Combined clot fragmentation and aspiration in patients with acute pulmonary embolism. Chest. 2008;134:54–60.