Diagnosis and Treatment of Pulmonary Embolism in Patients With COVID-19

A position paper recently published in CHEST by the National Pulmonary Embolism Response Team (PERT) outlines an approach for diagnosing and treating pulmonary embolism (PE) in patients with coronavirus disease 2019 (COVID-19).  

The COVID-19 era has complicated the diagnosis, risk stratification, and treatment of patients with PE. To meet this need, the PERT Board of Directors have outlined how a multidisciplinary team of specialists to treat patients with severe PE can be instrumental in the diagnosis and care of patients with suspected or confirmed PE and COVID-19.

Because patients with COVID-19 may exhibit a hypercoagulable state, the index of suspicion for concurrent PE should be high. In patients with clinical and imaging findings not entirely explained by COVID-19, evaluation for PE should be strongly considered. In addition, elevated D-dimer alone should not be used to diagnose suspected PE. PERT consultation should consider, when clinically allowable, COVID-19 testing and results as a means of risk stratification and to protect allied health care providers from the risk of viral transmission. For patients with mild COVID-19 symptoms and low-risk PE, outpatient treatment or early discharge may be considered, with close follow-up.

While indications and contraindications for thrombolysis remain unchanged, systemic thrombolysis may be a viable alternative in certain patients with COVID-19 who are appropriate candidates for advanced therapy but in whom an invasive approach may not available as a result of limited resources or concerns about viral transmission.

Follow-up assessment of patients with concomitant COVID-19 and PE is critical and should be virtual when possible. For all patients infected with COVID-19, exposure should be limited and digital platforms for information exchange should be used to make critical evidence-based management decisions.

“The PERT approach can significantly aid in the care of these vulnerable and complicated patients,” the authors concluded. “As more is learned about COVID-19, ongoing refinements will be necessary to address this vulnerable population.”

To learn more about the work from PERT, including the COVID-19 PE Registry, visit PertConsortium.org.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Rosovsky RP, Grodzin C, Channick R, et al; for the PERT Consortium. Diagnosis and treatment of pulmonary embolism during the COVID-19 pandemic: a position paper from the national PERT consortium. CHEST. Published online August 27, 2020. doi:10.1016/j.chest.2020.08.2064