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Volume 26, Number 8—August 2020
Research Letter

Pulmonary Embolism and Increased Levels of D-Dimer in Patients with Coronavirus Disease

Daniel O. GriffinComments to Author , Alexandra Jensen, Mushmoom Khan, Jessica Chin, Kelly Chin, Jennifer Saad, Ryan Parnell, Christopher Awwad, and Darshan Patel
Author affiliations: Columbia University Medical Center, New York, New York, USA (D.O. Griffin); Columbia University College of Physicians and Surgeons, New York (D.O. Griffin); Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA (A. Jensen, M. Khan, J. Chin, K. Chin, J. Saad, R. Parnell, C. Awwad, D. Patel)

Main Article

Table

Characteristics of pulmonary embolism seen by CTA and increased levels of d-dimer in 3 patients with COVID-19, New York, USA*

Characteristic Case-patient
1 2 3
Age, y
 52
 60
 68
Risk factors
 Allergic rhinitis, asthma
 Chronic bronchitis, history of ovarian cancer, and history of provoked DVT
 Hypertension, diabetes mellitus type 2
Smoking status Former Never Never
BMI, kg/m2 27.0 27.4 23.7
Creatinine clearance, mL/min
 116
 127.4
 64
Day of symptoms, baseline/CTA 12/18 8/18 14/22
O2 saturation, baseline/CTA 52% on RA/98% on NRB 92% on NC/91% on NC 94% on NRB/93% on NRB
d-dimer, μg/mL, baseline/CTA 2,283/9,698 221/2,563 33,318/1,554
Ferritin, μg/L, baseline/CTA 2,283/1,050 1,276/1,176 2,797/1,282
CRP, mg/L, baseline/CTA 32.30/0.42 11.89/0.66 8.88/0.25
Procalcitonin, ng/mL, baseline/CTA 0.19/0.05 0.05/0.13 0.23/NA
LDH, U/L, baseline/CTA 567/467 448/637 824/616
Neutrophil:lymphocyte ratio, baseline/CTA
 10.58/11.75
 6.6/7.5
 7.67/14.99
ISTH score, day of CTA >5 >5 >5
VTE prevention Enoxaparin, 40 mg 2×/d Enoxaparin, 40 mg 2×/d Enoxaparin, 40 mg/d
IMPROV score 0 3 1
Doses of tocilizumab 1 1 1
Methylprednisolone duration, d 8 5 5
Hydroxychloroquine duration, d
 5
 5
 5
CTA read Bilateral PE; filling defects most pronounced in the right lobar pulmonary artery extending to the first-order branches of the right lower lobe pulmonary artery; additional small filling defect identified within the right upper lobe, right middle lobe, and lingular pulmonary artery branches; diffuse scattered bilateral ground-glass opacities with areas of consolidation compatible with reported viral pneumonia COVID-19 Multiple bilateral segmental and subsegmental PE with suggestion of cardiac strain; bilateral scattered, predominantly peripheral ground-glass opacities with some interlobular septal thickening consistent with given history of COVID-19 pneumonia Central filling defects compatible with acute pulmonary embolism in several segmental and subsegmental pulmonary arteries in the right upper lobe, right lower lobe, and left lower lobe; diffuse bilateral ground-glass opacities unchanged from previous imaging

*BMI, body mass index; COVID-19, coronavirus disease; CRP, C-reactive protein; CTA, computed tomography angiogram; DVT, deep vein thrombosis; IMPROV, International Medical Prevention on Venous Thrombosis; ISTH, International Society of Thrombosis and Haemostasis; LDH, lactate dehydrogenase; NA, not available; NC, nasal cannula; NRB, nonrebreather; PE, pulmonary embolus; RA, room air; RLL, right lower lobe; VTE, venous thromboembolism.

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Page created: April 30, 2020
Page updated: July 18, 2020
Page reviewed: July 18, 2020
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