Abstract Number: LPB0009
Meeting: ISTH 2021 Congress
Background: Pulmonary embolism (PE) seems to be a prevalent complication in patients with Coronavirus disease 2019 (COVID-19). However, all studies thus far were retrospective analyses without systematic PE-screening, thus highly susceptible to selection bias. Therefore, the true prevalence of PE and optimal D-dimer cut-off cannot be derived from such studies.
Aims: We aimed to evaluate the true prevalence of PE in patients with suspected COVID-19 and the diagnostic yield of systematic PE screening.
Methods: We evaluated all patients with suspected COVID-19 who were admitted to our hospital via the Emergency Department between April 7th and May 31st 2020. Patients were assessed according to a prespecified clinical protocol and were evaluated for PE using the YEARS-algorithm. CT-pulmonary angiography (CTPA) was performed in case D-dimer levels were ≥1000 ng/mL, or ≥500 ng/mL if patients had ≥ 1 YEARS item (hemoptysis, clinical signs for deep vein thrombosis, and/or PE as the most likely diagnosis). Patients using anticoagulant drugs were excluded.
Results: 666 patients with suspected COVID-19 were included in the present analyses (Figure 1). CTPA was performed in 393 patients, revealing PE in 51 patients. Thus, 1 out of 7.7 CTPAs was positive for PE. Interestingly, the PE-prevalence did not differ between patients with COVID-19 (n=190) and those without (13.5% vs. 12.8%, p=0.87). D-dimer levels were higher in patients with PE (Figure 2). The lowest D-dimer value ruling out PE was 1258 μg/L. In multivariate regression analysis, only D-dimer was associated with PE (OR 1.07 for every 1000 μg/L increase, 95%CI 1.02-1.13, p=0.007).
Conclusions: In the first study on systematic PE screening in ED patients with suspected COVID-19, we found an overall PE prevalence of 7.7%. We believe this is a feasible approach for early PE-detection. Our analysis does not support the use of higher D-dimer thresholds to rule out PE in this population.
To cite this abstract in AMA style:Luu I, Kroon F, Buijs J, Krdzalic J, de Kruif M, Leers M, Mostard G, Martens R, Mostard R, van Twist D. Systematic Screening for Pulmonary Embolism in Patients with Suspected Covid-19 in the Emergency Department: A Prospective Cohort Study [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/systematic-screening-for-pulmonary-embolism-in-patients-with-suspected-covid-19-in-the-emergency-department-a-prospective-cohort-study/. Accessed November 29, 2021.
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