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In addition to the direct effects of SARS-CoV-2, several studies have found a higher than expected incidence of thrombotic events (pulmonary embolism [PE], deep venous thrombosis, stroke, myocardial infarction) in patients infected with the virus. However, most of these studies have been performed in inpatient settings, and the prevalence of thromboses in the general population is unknown.
In the current study, researchers retrospectively analyzed records for patients who underwent computed tomography pulmonary angiography (CTPA) in six New York City emergency departments (EDs) between April 1 and May 1, 2020. During that period, 18.8% of CTPA studies were positive for PE, compared with 7.6% during the same time period in 2019. Of patients with PE in 2020, 59.7% tested positive for SARS-CoV-2, nearly all during the ED visit; no positive patient had a prior visit for COVID-19 within the health system.
Watchmaker JM et al. Increased incidence of acute pulmonary embolism in emergency department patients during the COVID-19 pandemic. Acad Emerg Med 2020 Oct 5; [e-pub]. (https://doi.org/10.1111/ACEM.14148)
Comment
These results confirm that patients with COVID-19 have increased risk for thrombosis. However, there are several other potential explanations for the more than twofold increase in PE incidence, including a change in the acuity of patients presenting during the peak wave of COVID-19 and changes in clinician practice patterns and decisions about which patients need CT scans. Nevertheless, this study provides an important reminder to avoid premature diagnostic closure: although symptoms of COVID-19 and PE may be similar (dyspnea and hypoxemia), a patient positive for SARS-CoV-2 could very well also have a PE.