Pulmonary thromboembolism in hospitalised patients with COVID-19: a retrospective national study of patients managed in critical care and ward environments in Scotland
Objectives To assess for increase in pulmonary thromboembolism (PTE) in hospitalised patients with COVID-19, in both critical care and ward environments.Setting We reviewed all CT pulmonary angiograms (CTPA) performed in Scotland between 23 March 2020 and 31 May 2020 and identified those with COVID-...
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BMJ Publishing Group
2021-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/8/e050281.full |
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| author | Ninian N Lang Michael McGettrick Catherine Bagot M K Johnson Alistair Colin Church Alexander MacLellan Paul McCaughey Melanie J Brewis |
| author_facet | Ninian N Lang Michael McGettrick Catherine Bagot M K Johnson Alistair Colin Church Alexander MacLellan Paul McCaughey Melanie J Brewis |
| author_sort | Ninian N Lang |
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| description | Objectives To assess for increase in pulmonary thromboembolism (PTE) in hospitalised patients with COVID-19, in both critical care and ward environments.Setting We reviewed all CT pulmonary angiograms (CTPA) performed in Scotland between 23 March 2020 and 31 May 2020 and identified those with COVID-19 using either classical radiological appearances or positive COVID-19 PCR swab.Participants All hospitalised patients in Scotland with COVID-19 between 23 March 2020 and 31 May 2020 who underwent a CTPA.Primary outcome measure To assess if the rate of PTE was increased in those with COVID-19 compared with previously published figures of hospitalised patients.Secondary outcome measures To assess the effect of right heart strain or requirement for critical care on mortality.Results 3401 CTPAs were reviewed. 192 were positive for PTE in patients with evidence of COVID-19 either real-time PCR swab positive for SARS-CoV-2 (n=104) or having radiological changes consistent with COVID-19 (n=88). The total number of hospital admissions in Scotland between 23rd March 2020 and 31st May 2020 with COVID-19 was 5195. The incidence of PTE during this time was 3.7% in all patients admitted to all hospitals in Scotland with COVID-19 during this period. 475 hospitalised patients were managed in critical care (both level 2 and level 3 care), in whom the incidence of PTE was 6% (n=29). 4720 patients did not require admission to critical care, in whom the incidence of PTE was 3.5% (n=163). There was increased risk of death with right heart strain (25/52 vs 128/140 (p<0.01)) and in critical care (15/29 vs 146/163 (p<0.01)).Conclusions We have demonstrated an increased risk of PTE in critical care and ward-based environments. Further studies are required to establish effective prophylactic anticoagulation in this group. |
| format | Article |
| id | doaj-art-aaa3715c3507430780b17c3f4f89a558 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-08-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-aaa3715c3507430780b17c3f4f89a5582024-12-11T07:45:08ZengBMJ Publishing GroupBMJ Open2044-60552021-08-0111810.1136/bmjopen-2021-050281Pulmonary thromboembolism in hospitalised patients with COVID-19: a retrospective national study of patients managed in critical care and ward environments in ScotlandNinian N Lang0Michael McGettrick1Catherine Bagot2M K Johnson3Alistair Colin Church4Alexander MacLellan5Paul McCaughey6Melanie J Brewis7School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UKScottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Clydebank, UKDepartment of Haemostasis and Thrombosis, Glasgow Royal Infirmary, Glasgow, Glasgow, UKScottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Clydebank, UKScottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Clydebank, UKScottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Clydebank, UKScottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Clydebank, UKScottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Clydebank, UKObjectives To assess for increase in pulmonary thromboembolism (PTE) in hospitalised patients with COVID-19, in both critical care and ward environments.Setting We reviewed all CT pulmonary angiograms (CTPA) performed in Scotland between 23 March 2020 and 31 May 2020 and identified those with COVID-19 using either classical radiological appearances or positive COVID-19 PCR swab.Participants All hospitalised patients in Scotland with COVID-19 between 23 March 2020 and 31 May 2020 who underwent a CTPA.Primary outcome measure To assess if the rate of PTE was increased in those with COVID-19 compared with previously published figures of hospitalised patients.Secondary outcome measures To assess the effect of right heart strain or requirement for critical care on mortality.Results 3401 CTPAs were reviewed. 192 were positive for PTE in patients with evidence of COVID-19 either real-time PCR swab positive for SARS-CoV-2 (n=104) or having radiological changes consistent with COVID-19 (n=88). The total number of hospital admissions in Scotland between 23rd March 2020 and 31st May 2020 with COVID-19 was 5195. The incidence of PTE during this time was 3.7% in all patients admitted to all hospitals in Scotland with COVID-19 during this period. 475 hospitalised patients were managed in critical care (both level 2 and level 3 care), in whom the incidence of PTE was 6% (n=29). 4720 patients did not require admission to critical care, in whom the incidence of PTE was 3.5% (n=163). There was increased risk of death with right heart strain (25/52 vs 128/140 (p<0.01)) and in critical care (15/29 vs 146/163 (p<0.01)).Conclusions We have demonstrated an increased risk of PTE in critical care and ward-based environments. Further studies are required to establish effective prophylactic anticoagulation in this group.https://bmjopen.bmj.com/content/11/8/e050281.full |
| spellingShingle | Ninian N Lang Michael McGettrick Catherine Bagot M K Johnson Alistair Colin Church Alexander MacLellan Paul McCaughey Melanie J Brewis Pulmonary thromboembolism in hospitalised patients with COVID-19: a retrospective national study of patients managed in critical care and ward environments in Scotland BMJ Open |
| title | Pulmonary thromboembolism in hospitalised patients with COVID-19: a retrospective national study of patients managed in critical care and ward environments in Scotland |
| title_full | Pulmonary thromboembolism in hospitalised patients with COVID-19: a retrospective national study of patients managed in critical care and ward environments in Scotland |
| title_fullStr | Pulmonary thromboembolism in hospitalised patients with COVID-19: a retrospective national study of patients managed in critical care and ward environments in Scotland |
| title_full_unstemmed | Pulmonary thromboembolism in hospitalised patients with COVID-19: a retrospective national study of patients managed in critical care and ward environments in Scotland |
| title_short | Pulmonary thromboembolism in hospitalised patients with COVID-19: a retrospective national study of patients managed in critical care and ward environments in Scotland |
| title_sort | pulmonary thromboembolism in hospitalised patients with covid 19 a retrospective national study of patients managed in critical care and ward environments in scotland |
| url | https://bmjopen.bmj.com/content/11/8/e050281.full |
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