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VTE Week | PEPCOV – COVID-19 and PE Risk in Emergency Patients

September 17, 2020

Written by Clay Smith

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For ED patients, the probability of PE was the same in COVID-positive and COVID-negative patients. This does not apply to other hospitalized COVID-19 patient populations.

Why does this matter?
COVID-19 induces a hypercoagulable state. Inpatients have greater risk of VTE. What about patients presenting to the ED, presumably earlier in the course of the illness? Could COVID render PERC, YEARS, and Wells’ unsafe to use?

PE, COVID, the ED, your patients, and you
This was a retrospective study of 26 EDs in 6 countries that covered the 2-month peak of COVID-19 earlier this year and enrolled 3,253 patients with known COVID-status who had a CT pulmonary angiogram (CTPA). Of these, 30% (n=974) were positive for COVID-19; 15% (n=500) had a PE. The risk of PE was about 15% in both the COVID-19 positive and COVID-19 negative cohorts. There was no association with COVID-19 positive status and PE in this ED population; aOR 0.98 (95%CI 0.76 to 1.26). Performance of the Revised Geneva Score and D-dimer were similar in COVID positive and negative cohorts. However, only patients getting CTPA were enrolled, which means likely inclusion bias; performance in lower risk patients is unclear. What I take home from this is that patients in the ED who are COVID-positive appear to have a similar risk of PE to all-comers with possible PE symptoms. This says nothing about the broader risk of VTE in hospitalized COVID patients, especially those in the ICU, as we discussed yesterday.

Association between Pulmonary Embolism and COVID-19 in ED patients Undergoing CTPA: the PEPCOV international retrospective study. Acad Emerg Med. 2020 Jul 30. doi: 10.1111/acem.14096. Online ahead of print.

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What are your thoughts?