Pulmonary Embolism in Critically Ill COVID-19 And Non-COVID-19 Patients: Systematic Analysis of Risk Factors, Diagnostic and Management Strategies, and Prognosis.
Main Article Content
Abstract
Background: Coronavirus disease of 2019 or COVID-19 is characterised by two main features: the first is the respiratory compromise which corresponds to acute respiratory distress syndrome while the second corresponds to the state of hypercoagulability responsible for thromboembolic complications particularly pulmonary embolism which is the subject of this work. Indeed, a high prevalence of pulmonary embolism has been reported throughout the pandemic period with a significant morbidity and mortality. This reflects the severity of this life-threatening emergency chiefly in the elderly, hemodynamically unstable patients, and patients with severe underlying conditions, mainly cardio-pulmonary comorbidities. The aim of our study is to point out the incidence, the risk factors, the clinical and paraclinical features, the management strategies, and the overall prognosis of pulmonary embolism in critically ill COVID-19 and non-COVID-19 patients.
Patients and methods: It is a retrospective observational study carried out over a two-year-period from January 2019 (non-COVID-19) to December 2020 (COVID-19). Over the study period, 42 cases of COVID-19 and non-COVID-19 pulmonary embolism were collected from an overall set of 611 patients admitted to the medical intensive care unit of the IBN ROCHD university hospital of Casablanca.
Results: The mean age in the COVID-19 group was 64-year-old versus 46-year-old in the non-COVID-19 group. The sex ratio was 1.2 and 0.94 in the non-COVID-19 and COVID-19 group, respectively. Clinical symptomatology was dominated by respiratory failure and chest pain in non-COVID-19 patients while in the COVID-19 group, semiology was dominated by dyspnea, cough, and chest pain. The major sign of severity in both groups was tachypnea.
The chest X-ray was performed in all our patients, it displayed radiological abnormalities in all patients mainly hyper clarity in pulmonary fields. D-dimers were performed in all patients within the two study groups. A chest computed tomography angiogram was performed for all patients and showed unilateral pulmonary embolism in 61% of cases in the non-COVID-19 group versus 61.3% in the COVID-19 group. Cardiac ultrasound was performed for all patients. It showed dilatation of right cavities in both groups (81.8% in non-COVID-19 versus 93.5% in COVID-19 patients). Venous ultrasound of the lower limbs was performed in 96.8% of COVID-19 patients and in 72.7% of non-COVID-19 patients.
With regards to management, all COVID-19 and non-COVID-19 patients received anticoagulation therapy based on standard heparin and anti-vitamin K. Mortality accounted for 54.5% in non-COVID-19 patients versus 74.2% in COVID-19 patients.
Conclusion: COVID-19 pulmonary embolism is often associated with significantly higher morbidity and mortality as compared with non-COVID-19 pulmonary embolism.
Keywords:
Pulmonary embolism, Intensive care unit, COVID-19, Risk factors, Mortality
Article Details
How to Cite
CHARRA, Boubaker; BOU-OUHRICH, Yassine.
Pulmonary Embolism in Critically Ill COVID-19 And Non-COVID-19 Patients: Systematic Analysis of Risk Factors, Diagnostic and Management Strategies, and Prognosis..
Medical Research Archives, [S.l.], v. 11, n. 4, apr. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3759>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v11i4.3759.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Vyas V, Goyal A. Acute Pulmonary Embolism. PubMed. Published 2022. Accessed February 16, 2023. https://www.ncbi.nlm.nih.gov/books/NBK560551/#_ncbi_dlg_citbx_NBK560551
2. Pessinaba S, Molba YD, Baragou S, et al. L’embolie pulmonaire au centre hospitalier universitaire Campus de Lomé (Togo): étude rétrospective à propos de 51 cas. Pan African Medical Journal. 2017;27. doi:https://doi.org/10.11604/pamj.2017.27.129.6855
3. Rotzinger DC, Beigelman-Aubry C, von Garnier C, Qanadli SD. Pulmonary embolism in patients with COVID-19: Time to change the paradigm of computed tomography. Thrombosis Research. 2020;190:58-59. doi:https://doi.org/10.1016/j.thromres.2020.04.011
4. Martin AI, Rao G. COVID-19: A Potential Risk Factor for Acute Pulmonary Embolism. Methodist DeBakey Cardiovascular Journal. 2020;16(2):155-157. doi:https://doi.org/10.14797/mdcj-16-2-155
5. Olié V, Chin F, De Peretti C. La maladie veineuse thromboembolique: patients hospitalisés et mortalité en France en 2010. Journal des Maladies Vasculaires. 2013;38(5):308.
6. Rotzinger DC, Beigelman-Aubry C, von Garnier C, Qanadli SD. Pulmonary embolism in patients with COVID-19: Time to change the paradigm of computed tomography. Thrombosis Research. 2020;190:58-59. doi:https://doi.org/10.1016/j.thromres.2020.04.011
7. Audo A, Bonato V, Cavozza C, Maj G, Pistis G, Secco GG. Acute Pulmonary Embolism in SARS-CoV-2 Infection Treated with Surgical Embolectomy. The Annals of Thoracic Surgery. Published online April 2020. doi:https://doi.org/10.1016/j.athoracsur.2020.04.013
8. Sulemane S, Baltabaeva A, Barron AJ, Chester R, Rahman-Haley S. Acute pulmonary embolism in conjunction with intramural right ventricular thrombus in a SARS-CoV-2-positive patient. European Heart Journal - Cardiovascular Imaging. 2020;21(9):1054-1054. doi:https://doi.org/10.1093/ehjci/jeaa115
9. Wichmann D, Sperhake JP, Lütgehetmann M, et al. Autopsy Findings and Venous Thromboembolism in Patients With COVID-19. Annals of Internal Medicine. 2020;173(4). doi:https://doi.org/10.7326/m20-2003
10. Klok FA, Kruip MJHA, van der Meer NJM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thrombosis Research. Published online April 30, 2020. doi:https://doi.org/10.1016/j.thromres.2020.04.041
11. Lodigiani C, Iapichino G, Carenzo L, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thrombosis Research. 2020;191:9-14. doi:https://doi.org/10.1016/j.thromres.2020.04.024
12. Grillet F, Behr J, Calame P, Aubry S, Delabrousse E. Acute Pulmonary Embolism Associated with COVID-19 Pneumonia Detected by Pulmonary CT Angiography. Radiology. Published online April 23, 2020:201544. doi:https://doi.org/10.1148/radiol.2020201544
13. Bahloul, Mabrouk, Anis Chaari, Hassen Dammak, Leila Abid, Daoud Salima, Hichem Ksibi, Mohamed Samet, et Mounir Bouaziz. « l’embolie Pulmonaire fibrino-cruorique : fréquence, Physiopathologie, tableau clinique et traitement ». LA TUNISIE MEDICALE 92 (2014): 13.
14. Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous Thromboembolism. American Journal of Preventive Medicine. 2010;38(4):S495-S501. doi:https://doi.org/10.1016/j.amepre.2009.12.017
15. Casey K, Iteen A, Nicolini R, Auten J. COVID-19 pneumonia with hemoptysis: Acute segmental pulmonary emboli associated with novel coronavirus infection. The American Journal of Emergency Medicine. Published online April 2020. doi:https://doi.org/10.1016/j.ajem.2020.04.011
16. Barbara Lambert. L’embolie pulmonaire en pratique clinique à propos de 839 cas consécutifs en Hôpital Général :Etude STEP.Le 12 Novembre 2003.
17. A.Abbadi. L’embolie pulmonaire (A propos de 40 cas). CHU de Fès 2015.
18. Galeano-Valle F, Oblitas CM, Ferreiro-Mazón MM, et al. Antiphospholipid antibodies are not elevated in patients with severe COVID-19 pneumonia and venous thromboembolism. Thrombosis Research. 2020;192:113-115. doi:https://doi.org/10.1016/j.thromres.2020.05.017
19. Danzi GB, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association? European Heart Journal. Published online March 30, 2020. doi:https://doi.org/10.1093/eurheartj/ehaa254
20. Jafari R, Cegolon L, Jafari A, et al. Large saddle pulmonary embolism in a woman infected by COVID-19 pneumonia. European Heart Journal. 2020;41(22):2133-2133. doi:https://doi.org/10.1093/eurheartj/ehaa402
21. Cellina M, Oliva G. Acute pulmonary embolism in a patient with COVID-19 pneumonia. Diagnostic and Interventional Imaging. Published online April 10, 2020. doi:https://doi.org/10.1016/j.diii.2020.04.001
22. Ullah W, Saeed R, Sarwar U, Patel R, Fischman DL. COVID-19 complicated by Acute Pulmonary Embolism and Right-Sided Heart Failure. JACC: Case Reports. Published online April 2020. doi:https://doi.org/10.1016/j.jaccas.2020.04.008
23. Harsch IA, Skiba M, Konturek PC. SARS-CoV-2 pneumonia and pulmonary embolism in a 66-year-old female. Polish Archives of Internal Medicine. Published online May 1, 2020. doi:https://doi.org/10.20452/pamw.15333
24. Le Berre A, Marteau V, Emmerich J, Zins M. Concomitant acute aortic thrombosis and pulmonary embolism complicating COVID-19 pneumonia. Diagnostic and Interventional Imaging. 2020;101(5):321-322. doi:https://doi.org/10.1016/j.diii.2020.04.003
25. Fabre O, Rebet O, Carjaliu I, Radutoiu M, Gautier L, Hysi I. Severe Acute Proximal Pulmonary Embolism and COVID-19: A Word of Caution. The Annals of Thoracic Surgery. 2020;110(5):e409-e411. doi:https://doi.org/10.1016/j.athoracsur.2020.04.005
26. Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. European heart journal. 2014;35(43):3033-3069, 3069a3069k. doi:https://doi.org/10.1093/eurheartj/ehu283
27. Merli G. Diagnostic assessment of deep vein thrombosis and pulmonary embolism. The American Journal of Medicine. 2005;118(8):3-12. doi:https://doi.org/10.1016/j.amjmed.2005.06.008
28. Cherkaoui S. Prise en charge de l’embolie pulmonaire: étude rétrospective à propos de 33 cas. Rabat: Faculté de medecine et de pharmacie; 2011.
29. M. Ouassari. embolie pulmonaire particularités épidémiologiques, cliniques et thérapeutiques etuderetospectiveaproppot de 91 cas. Rabat 2016.
30. Ouldzein H, Nourredine A, Cherradi R, Rahal N, Mechmeche R, Haouala H. Prise en charge de l’embolie pulmonaire en milieu cardiologique: expérience d’un hôpital tunisien. Annales de Cardiologie et d’Angéiologie. 2008;57(1):52-57. doi:https://doi.org/10.1016/j.ancard.2007.01.002
31. DI CASTELNUOVO, Augusto, COSTANZO, Simona, ANTINORI, Andrea, et al. Heparin in COVID-19 patients is associated with reduced in-hospital mortality: the multicenter Italian CORIST study. Thrombosis and haemostasis, 2021, vol. 121, no 08, p. 1054-1065.
32. Tucker LY, Vieira A, Ding D. Surgical Outcomes after Bucket Handle Meniscus Repairs: analysis of a large contained cohort study. Orthopaedic Journal of Sports Medicine. 2021;9(7_suppl4):2325967121S0020. doi:https://doi.org/10.1177/2325967121s00204
33. Girardi AM, Bettiol RS, Garcia TS, et al. Wells and Geneva Scores Are Not Reliable Predictors of Pulmonary Embolism in Critically Ill Patients: A Retrospective Study. Journal of Intensive Care Medicine. 2018;35(10):1112-1117. doi:https://doi.org/10.1177/0885066618816280
34. Kirsch BA, Aziz MK, Kumar SD, et al. Wells Score to Predict Pulmonary Embolism in Patients with Coronavirus Disease-2019. SSRN Electronic Journal. Published online 2020. doi:https://doi.org/10.2139/ssrn.3679989
35. May JE, Lauzon SD, Godby RC, Kanter J. Confirmation of the utility of the Wells’ Score for pulmonary embolism in patients with sickle cell disease. Journal of Thrombosis and Thrombolysis. 2022;54(1):193-196. doi:https://doi.org/10.1007/s11239-022-02656-y
36. Z.Sabrei. PRISE EN CHARGE DE L’EMBOLIE PULMONAIRE Expérience du service de Pneumologie de l’Hôpital Militaire Moulay Ismail de Meknès (à propos de 18 cas).
37. Becattini C, Vedovati MC, Agnelli G. Prognostic Value of Troponins in Acute Pulmonary Embolism. Circulation. 2007;116(4):427-433. doi:https://doi.org/10.1161/circulationaha.106.680421
38. Paul D.SteinM.D., F.C.C.P : Clinical, Laboratory, Roentgenographic, and Electrocardiographic Findings in Patients with Acute Pulmonary Embolism and No Pre-Existing Cardiac or Pulmonary Disease.
39. Rodger M, Makropoulos D, Turek M, et al. Diagnostic value of the electrocardiogram in suspected pulmonary embolism. The American Journal of Cardiology. 2000;86(7):807-809. doi:https://doi.org/10.1016/s0002-9149(00)01090-0
40. Petrov DB. Appearance of right bundle branch block in electrocardiograms of patients with pulmonary embolism as a marker for obstruction of the main pulmonary trunk. Journal of Electrocardiology. 2001;34(3):185-188. doi:https://doi.org/10.1054/jelc.2001.25132
41. Casazza F, Bongarzoni A, Centonze F, Morpurgo M. Prevalence and prognostic significance of right-sided cardiac mobile thrombi in acute massive pulmonary embolism. The American Journal of Cardiology. 1997;79(10):1433-1435. doi:https://doi.org/10.1016/s0002-9149(97)00162-8
42. Colombier D, Victor G, Elias M, et al. Diagnostic performance of complete lower limb venous ultrasound in patients with clinically suspected acute pulmonary embolism. Thrombosis and Haemostasis. 2004;91(01):187-195. doi:https://doi.org/10.1160/th03-05-0278
43. RIGHINI M, LE GAL G, AUJESKY D, et al. Complete venous ultrasound in outpatients with suspected pulmonary embolism. Journal of Thrombosis and Haemostasis. 2009;7(3):406-412. doi:https://doi.org/10.1111/j.1538-7836.2008.03264.x
44. Verschuren F, Roy PM ., Thys F, et al. Le diagnostic de l’embolie pulmonaire par le CT-scanner multidétecteur seul ou combiné au doppler veineux des membres inférieurs : essai randomisé de non-infériorité. Journal Européen des Urgences. 2008;21:A88. doi:https://doi.org/10.1016/j.jeur.2008.03.301
45. Ongaro G, Righini M, Perrier A, Marti C. D-dimères et suspicion d’embolie pulmonaire: Seuil adapté à l’âge. Rev Med Suisse. 2014;10(446):1908–12.
46. M.Hassouni. Prise en charge de l’embolie pulmonaire dans le CHU de Tlemcen : Étude rétrospective portée sur 19 cas.
47. RODGER MARC A, CARRIER M, JONES GWYNNE N, et al. Diagnostic Value of Arterial Blood Gas Measurement in Suspected Pulmonary Embolism. American Journal of Respiratory and Critical Care Medicine. 2000;162(6):2105-2108. doi:https://doi.org/10.1164/ajrccm.162.6.2004204
48. Pulido T, Aranda A, Zevallos MA, et al. Pulmonary Embolism as a Cause of Death in Patients With Heart Disease. Chest. 2006;129(5):1282-1287. doi:https://doi.org/10.1378/chest.129.5.1282
49. Aujesky D, Obrosky DS, Stone RA, et al. A Prediction Rule to Identify Low-Risk Patients With Pulmonary Embolism. Archives of Internal Medicine. 2006;166(2):169. doi:https://doi.org/10.1001/archinte.166.2.169
50. Aazri L, Bougadoum M, Ait Batahar S, Amro L. L’embolie pulmonaire au cours de la BPCO : prévalence, moyens diagnostiques, et scores prédictifs de gravité. Revue des Maladies Respiratoires Actualités. 2021;13(1):50. doi:https://doi.org/10.1016/j.rmra.2020.11.089
51. JEAN-MARC, Monsieur le Docteur BOYER. Les scores PESI et HESTIA pour identifier les patients éligibles à une prise en charge ambulatoire après un diagnostic d’embolie pulmonaire.
52. Xu H, Martin A, Singh A, et al. Pulmonary Embolism in Patients Hospitalized With COVID-19 (From a New York Health System). The American Journal of Cardiology. 2020;133:148-153. doi:https://doi.org/10.1016/j.amjcard.2020.07.036
53. Muñoz OM, Ruiz-Talero P, Hernández-Florez C, Lombo-Moreno CE, Casallas-Rivera MA, Mayorga-Hernández CA. Validation of the PESI Scale to Predict in-Hospital Mortality in Patients with Pulmonary Thromboembolism Secondary to SARS CoV − 2 Infection. Clinical and Applied Thrombosis/Hemostasis. 2022;28:107602962211029. doi:https://doi.org/10.1177/10760296221102940
54. Cindryani M, H. George Y. Possible associations between central venous pressure, D-Dimer, and pulmonary embolism severity index in COVID-19 acute respiratory distress syndrome patients. Bali Journal of Anesthesiology. 2021;5(3):208. doi:https://doi.org/10.4103/bjoa.bjoa_6_21
55. MERCAT A, ORLIAGUET G. Traitement symptomatique de la défaillance cardiorespiratoire de l’embolie pulmonaire grave. Réanimation. 2001;10(5):495-498. doi:https://doi.org/10.1016/s1164-6756(01)00151-7
56. Meyer G. Embolie pulmonaire. EMC - Anesthésie-Réanimation. 2013;10(2):1-18. doi:https://doi.org/10.1016/s0246-0289(12)59051-1
57. Planquette B, Belmont L, Meyer G, Sanchez O. Prise en charge diagnostique et thérapeutique de l’embolie pulmonaire grave. Revue des Maladies Respiratoires. 2011;28(6):778-789. doi:https://doi.org/10.1016/j.rmr.2010.11.006
58. Ellis C, Kaiser D. The clinical efficacy of dabigatran etexilate for preventing stroke in atrial fibrillation patients. Vascular Health and Risk Management. Published online July 2013:341. doi:https://doi.org/10.2147/vhrm.s28271
59. Cossette B, Pelletier MÈ, Carrier N, et al. Evaluation of Bleeding Risk in Patients Exposed to Therapeutic Unfractionated or Low-Molecular Weight Heparin: A Cohort Study in the Context of a Quality Improvement Initiative. Annals of Pharmacotherapy. 2010;44(6):994-1002. doi:https://doi.org/10.1345/aph.1m615
60. Prandoni P. The incidence of heparin-induced thrombocytopenia in medical patients treated with low-molecular-weight heparin: a prospective cohort study. Blood. 2005;106(9):3049-3054. doi:https://doi.org/10.1182/blood-2005-03-0912
61. Pizov R. Subcutaneous Fondaparinux Versus Intravenous Unfractionated Heparin in the Initial Treatment of Pulmonary Embolism. Survey of Anesthesiology. 2004;48(4):173-174. doi:https://doi.org/10.1097/01.sa.0000131997.94738.a2
62. Hirsh J, Raschke R. Heparin and Low-Molecular-Weight Heparin. Chest. 2004;126(3):188S203S. doi:https://doi.org/10.1378/chest.126.3_suppl.188s
63. Turpie AGG, Eriksson BI, Lassen MR, Bauer KA. Fondaparinux, the first selective factor Xa inhibitor. Current Opinion in Hematology. 2003;10(5):327-332. doi:https://doi.org/10.1097/00062752-200309000-00001
64. Ucar EY, Araz O, Akgun M, et al. Low-Molecular-Weight Heparin Use with Thrombolysis: Is it Effective and Safe? Ten Years’ Clinical Experience. Respiration. 2013;86(4):318-323. doi:https://doi.org/10.1159/000346203
65. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmau_rice D, Galiè N, Gibbs JSR, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Noordegraaf AV, Zamorano JL, Zompatori M, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol Ç, Fagard R, Agewall S, Asteggiano R, Bauersachs R, Becattini C, Bounameaux H, Büller HR, Davos CH, Geersing GJ, Sanchez MAG, Hendriks J, Kilickap M, Mareev V, Monreal M, Morais J, Popescu BA, Sanchez O, Spy_ropoulos AC, (2014) 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35: 3033–3080.
66. Engelberger RP, Kucher N. Catheter-Based Reperfusion Treatment of Pulmonary Embolism. Circulation. 2011;124(19):2139-2144. doi:https://doi.org/10.1161/circulationaha.111.023689
67. Kucher N. Catheter Embolectomy for Acute Pulmonary Embolism. Chest. 2007;132(2):657-663. doi:https://doi.org/10.1378/chest.07-0665
68. Achkar A, Horellou MH ., Parent F, et al. Le traitement antithrombotique de la maladie thromboembolique veineuse. Revue des Maladies Respiratoires. 2005;22(5):833-835. doi:https://doi.org/10.1016/s0761-8425(05)85645-1
69. FARGE D, DEBOURDEAU P, BECKERS M, et al. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Journal of Thrombosis and Haemostasis. 2013;11(1):56-70. doi:https://doi.org/10.1111/jth.12070
2. Pessinaba S, Molba YD, Baragou S, et al. L’embolie pulmonaire au centre hospitalier universitaire Campus de Lomé (Togo): étude rétrospective à propos de 51 cas. Pan African Medical Journal. 2017;27. doi:https://doi.org/10.11604/pamj.2017.27.129.6855
3. Rotzinger DC, Beigelman-Aubry C, von Garnier C, Qanadli SD. Pulmonary embolism in patients with COVID-19: Time to change the paradigm of computed tomography. Thrombosis Research. 2020;190:58-59. doi:https://doi.org/10.1016/j.thromres.2020.04.011
4. Martin AI, Rao G. COVID-19: A Potential Risk Factor for Acute Pulmonary Embolism. Methodist DeBakey Cardiovascular Journal. 2020;16(2):155-157. doi:https://doi.org/10.14797/mdcj-16-2-155
5. Olié V, Chin F, De Peretti C. La maladie veineuse thromboembolique: patients hospitalisés et mortalité en France en 2010. Journal des Maladies Vasculaires. 2013;38(5):308.
6. Rotzinger DC, Beigelman-Aubry C, von Garnier C, Qanadli SD. Pulmonary embolism in patients with COVID-19: Time to change the paradigm of computed tomography. Thrombosis Research. 2020;190:58-59. doi:https://doi.org/10.1016/j.thromres.2020.04.011
7. Audo A, Bonato V, Cavozza C, Maj G, Pistis G, Secco GG. Acute Pulmonary Embolism in SARS-CoV-2 Infection Treated with Surgical Embolectomy. The Annals of Thoracic Surgery. Published online April 2020. doi:https://doi.org/10.1016/j.athoracsur.2020.04.013
8. Sulemane S, Baltabaeva A, Barron AJ, Chester R, Rahman-Haley S. Acute pulmonary embolism in conjunction with intramural right ventricular thrombus in a SARS-CoV-2-positive patient. European Heart Journal - Cardiovascular Imaging. 2020;21(9):1054-1054. doi:https://doi.org/10.1093/ehjci/jeaa115
9. Wichmann D, Sperhake JP, Lütgehetmann M, et al. Autopsy Findings and Venous Thromboembolism in Patients With COVID-19. Annals of Internal Medicine. 2020;173(4). doi:https://doi.org/10.7326/m20-2003
10. Klok FA, Kruip MJHA, van der Meer NJM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thrombosis Research. Published online April 30, 2020. doi:https://doi.org/10.1016/j.thromres.2020.04.041
11. Lodigiani C, Iapichino G, Carenzo L, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thrombosis Research. 2020;191:9-14. doi:https://doi.org/10.1016/j.thromres.2020.04.024
12. Grillet F, Behr J, Calame P, Aubry S, Delabrousse E. Acute Pulmonary Embolism Associated with COVID-19 Pneumonia Detected by Pulmonary CT Angiography. Radiology. Published online April 23, 2020:201544. doi:https://doi.org/10.1148/radiol.2020201544
13. Bahloul, Mabrouk, Anis Chaari, Hassen Dammak, Leila Abid, Daoud Salima, Hichem Ksibi, Mohamed Samet, et Mounir Bouaziz. « l’embolie Pulmonaire fibrino-cruorique : fréquence, Physiopathologie, tableau clinique et traitement ». LA TUNISIE MEDICALE 92 (2014): 13.
14. Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous Thromboembolism. American Journal of Preventive Medicine. 2010;38(4):S495-S501. doi:https://doi.org/10.1016/j.amepre.2009.12.017
15. Casey K, Iteen A, Nicolini R, Auten J. COVID-19 pneumonia with hemoptysis: Acute segmental pulmonary emboli associated with novel coronavirus infection. The American Journal of Emergency Medicine. Published online April 2020. doi:https://doi.org/10.1016/j.ajem.2020.04.011
16. Barbara Lambert. L’embolie pulmonaire en pratique clinique à propos de 839 cas consécutifs en Hôpital Général :Etude STEP.Le 12 Novembre 2003.
17. A.Abbadi. L’embolie pulmonaire (A propos de 40 cas). CHU de Fès 2015.
18. Galeano-Valle F, Oblitas CM, Ferreiro-Mazón MM, et al. Antiphospholipid antibodies are not elevated in patients with severe COVID-19 pneumonia and venous thromboembolism. Thrombosis Research. 2020;192:113-115. doi:https://doi.org/10.1016/j.thromres.2020.05.017
19. Danzi GB, Loffi M, Galeazzi G, Gherbesi E. Acute pulmonary embolism and COVID-19 pneumonia: a random association? European Heart Journal. Published online March 30, 2020. doi:https://doi.org/10.1093/eurheartj/ehaa254
20. Jafari R, Cegolon L, Jafari A, et al. Large saddle pulmonary embolism in a woman infected by COVID-19 pneumonia. European Heart Journal. 2020;41(22):2133-2133. doi:https://doi.org/10.1093/eurheartj/ehaa402
21. Cellina M, Oliva G. Acute pulmonary embolism in a patient with COVID-19 pneumonia. Diagnostic and Interventional Imaging. Published online April 10, 2020. doi:https://doi.org/10.1016/j.diii.2020.04.001
22. Ullah W, Saeed R, Sarwar U, Patel R, Fischman DL. COVID-19 complicated by Acute Pulmonary Embolism and Right-Sided Heart Failure. JACC: Case Reports. Published online April 2020. doi:https://doi.org/10.1016/j.jaccas.2020.04.008
23. Harsch IA, Skiba M, Konturek PC. SARS-CoV-2 pneumonia and pulmonary embolism in a 66-year-old female. Polish Archives of Internal Medicine. Published online May 1, 2020. doi:https://doi.org/10.20452/pamw.15333
24. Le Berre A, Marteau V, Emmerich J, Zins M. Concomitant acute aortic thrombosis and pulmonary embolism complicating COVID-19 pneumonia. Diagnostic and Interventional Imaging. 2020;101(5):321-322. doi:https://doi.org/10.1016/j.diii.2020.04.003
25. Fabre O, Rebet O, Carjaliu I, Radutoiu M, Gautier L, Hysi I. Severe Acute Proximal Pulmonary Embolism and COVID-19: A Word of Caution. The Annals of Thoracic Surgery. 2020;110(5):e409-e411. doi:https://doi.org/10.1016/j.athoracsur.2020.04.005
26. Konstantinides SV, Torbicki A, Agnelli G, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. European heart journal. 2014;35(43):3033-3069, 3069a3069k. doi:https://doi.org/10.1093/eurheartj/ehu283
27. Merli G. Diagnostic assessment of deep vein thrombosis and pulmonary embolism. The American Journal of Medicine. 2005;118(8):3-12. doi:https://doi.org/10.1016/j.amjmed.2005.06.008
28. Cherkaoui S. Prise en charge de l’embolie pulmonaire: étude rétrospective à propos de 33 cas. Rabat: Faculté de medecine et de pharmacie; 2011.
29. M. Ouassari. embolie pulmonaire particularités épidémiologiques, cliniques et thérapeutiques etuderetospectiveaproppot de 91 cas. Rabat 2016.
30. Ouldzein H, Nourredine A, Cherradi R, Rahal N, Mechmeche R, Haouala H. Prise en charge de l’embolie pulmonaire en milieu cardiologique: expérience d’un hôpital tunisien. Annales de Cardiologie et d’Angéiologie. 2008;57(1):52-57. doi:https://doi.org/10.1016/j.ancard.2007.01.002
31. DI CASTELNUOVO, Augusto, COSTANZO, Simona, ANTINORI, Andrea, et al. Heparin in COVID-19 patients is associated with reduced in-hospital mortality: the multicenter Italian CORIST study. Thrombosis and haemostasis, 2021, vol. 121, no 08, p. 1054-1065.
32. Tucker LY, Vieira A, Ding D. Surgical Outcomes after Bucket Handle Meniscus Repairs: analysis of a large contained cohort study. Orthopaedic Journal of Sports Medicine. 2021;9(7_suppl4):2325967121S0020. doi:https://doi.org/10.1177/2325967121s00204
33. Girardi AM, Bettiol RS, Garcia TS, et al. Wells and Geneva Scores Are Not Reliable Predictors of Pulmonary Embolism in Critically Ill Patients: A Retrospective Study. Journal of Intensive Care Medicine. 2018;35(10):1112-1117. doi:https://doi.org/10.1177/0885066618816280
34. Kirsch BA, Aziz MK, Kumar SD, et al. Wells Score to Predict Pulmonary Embolism in Patients with Coronavirus Disease-2019. SSRN Electronic Journal. Published online 2020. doi:https://doi.org/10.2139/ssrn.3679989
35. May JE, Lauzon SD, Godby RC, Kanter J. Confirmation of the utility of the Wells’ Score for pulmonary embolism in patients with sickle cell disease. Journal of Thrombosis and Thrombolysis. 2022;54(1):193-196. doi:https://doi.org/10.1007/s11239-022-02656-y
36. Z.Sabrei. PRISE EN CHARGE DE L’EMBOLIE PULMONAIRE Expérience du service de Pneumologie de l’Hôpital Militaire Moulay Ismail de Meknès (à propos de 18 cas).
37. Becattini C, Vedovati MC, Agnelli G. Prognostic Value of Troponins in Acute Pulmonary Embolism. Circulation. 2007;116(4):427-433. doi:https://doi.org/10.1161/circulationaha.106.680421
38. Paul D.SteinM.D., F.C.C.P : Clinical, Laboratory, Roentgenographic, and Electrocardiographic Findings in Patients with Acute Pulmonary Embolism and No Pre-Existing Cardiac or Pulmonary Disease.
39. Rodger M, Makropoulos D, Turek M, et al. Diagnostic value of the electrocardiogram in suspected pulmonary embolism. The American Journal of Cardiology. 2000;86(7):807-809. doi:https://doi.org/10.1016/s0002-9149(00)01090-0
40. Petrov DB. Appearance of right bundle branch block in electrocardiograms of patients with pulmonary embolism as a marker for obstruction of the main pulmonary trunk. Journal of Electrocardiology. 2001;34(3):185-188. doi:https://doi.org/10.1054/jelc.2001.25132
41. Casazza F, Bongarzoni A, Centonze F, Morpurgo M. Prevalence and prognostic significance of right-sided cardiac mobile thrombi in acute massive pulmonary embolism. The American Journal of Cardiology. 1997;79(10):1433-1435. doi:https://doi.org/10.1016/s0002-9149(97)00162-8
42. Colombier D, Victor G, Elias M, et al. Diagnostic performance of complete lower limb venous ultrasound in patients with clinically suspected acute pulmonary embolism. Thrombosis and Haemostasis. 2004;91(01):187-195. doi:https://doi.org/10.1160/th03-05-0278
43. RIGHINI M, LE GAL G, AUJESKY D, et al. Complete venous ultrasound in outpatients with suspected pulmonary embolism. Journal of Thrombosis and Haemostasis. 2009;7(3):406-412. doi:https://doi.org/10.1111/j.1538-7836.2008.03264.x
44. Verschuren F, Roy PM ., Thys F, et al. Le diagnostic de l’embolie pulmonaire par le CT-scanner multidétecteur seul ou combiné au doppler veineux des membres inférieurs : essai randomisé de non-infériorité. Journal Européen des Urgences. 2008;21:A88. doi:https://doi.org/10.1016/j.jeur.2008.03.301
45. Ongaro G, Righini M, Perrier A, Marti C. D-dimères et suspicion d’embolie pulmonaire: Seuil adapté à l’âge. Rev Med Suisse. 2014;10(446):1908–12.
46. M.Hassouni. Prise en charge de l’embolie pulmonaire dans le CHU de Tlemcen : Étude rétrospective portée sur 19 cas.
47. RODGER MARC A, CARRIER M, JONES GWYNNE N, et al. Diagnostic Value of Arterial Blood Gas Measurement in Suspected Pulmonary Embolism. American Journal of Respiratory and Critical Care Medicine. 2000;162(6):2105-2108. doi:https://doi.org/10.1164/ajrccm.162.6.2004204
48. Pulido T, Aranda A, Zevallos MA, et al. Pulmonary Embolism as a Cause of Death in Patients With Heart Disease. Chest. 2006;129(5):1282-1287. doi:https://doi.org/10.1378/chest.129.5.1282
49. Aujesky D, Obrosky DS, Stone RA, et al. A Prediction Rule to Identify Low-Risk Patients With Pulmonary Embolism. Archives of Internal Medicine. 2006;166(2):169. doi:https://doi.org/10.1001/archinte.166.2.169
50. Aazri L, Bougadoum M, Ait Batahar S, Amro L. L’embolie pulmonaire au cours de la BPCO : prévalence, moyens diagnostiques, et scores prédictifs de gravité. Revue des Maladies Respiratoires Actualités. 2021;13(1):50. doi:https://doi.org/10.1016/j.rmra.2020.11.089
51. JEAN-MARC, Monsieur le Docteur BOYER. Les scores PESI et HESTIA pour identifier les patients éligibles à une prise en charge ambulatoire après un diagnostic d’embolie pulmonaire.
52. Xu H, Martin A, Singh A, et al. Pulmonary Embolism in Patients Hospitalized With COVID-19 (From a New York Health System). The American Journal of Cardiology. 2020;133:148-153. doi:https://doi.org/10.1016/j.amjcard.2020.07.036
53. Muñoz OM, Ruiz-Talero P, Hernández-Florez C, Lombo-Moreno CE, Casallas-Rivera MA, Mayorga-Hernández CA. Validation of the PESI Scale to Predict in-Hospital Mortality in Patients with Pulmonary Thromboembolism Secondary to SARS CoV − 2 Infection. Clinical and Applied Thrombosis/Hemostasis. 2022;28:107602962211029. doi:https://doi.org/10.1177/10760296221102940
54. Cindryani M, H. George Y. Possible associations between central venous pressure, D-Dimer, and pulmonary embolism severity index in COVID-19 acute respiratory distress syndrome patients. Bali Journal of Anesthesiology. 2021;5(3):208. doi:https://doi.org/10.4103/bjoa.bjoa_6_21
55. MERCAT A, ORLIAGUET G. Traitement symptomatique de la défaillance cardiorespiratoire de l’embolie pulmonaire grave. Réanimation. 2001;10(5):495-498. doi:https://doi.org/10.1016/s1164-6756(01)00151-7
56. Meyer G. Embolie pulmonaire. EMC - Anesthésie-Réanimation. 2013;10(2):1-18. doi:https://doi.org/10.1016/s0246-0289(12)59051-1
57. Planquette B, Belmont L, Meyer G, Sanchez O. Prise en charge diagnostique et thérapeutique de l’embolie pulmonaire grave. Revue des Maladies Respiratoires. 2011;28(6):778-789. doi:https://doi.org/10.1016/j.rmr.2010.11.006
58. Ellis C, Kaiser D. The clinical efficacy of dabigatran etexilate for preventing stroke in atrial fibrillation patients. Vascular Health and Risk Management. Published online July 2013:341. doi:https://doi.org/10.2147/vhrm.s28271
59. Cossette B, Pelletier MÈ, Carrier N, et al. Evaluation of Bleeding Risk in Patients Exposed to Therapeutic Unfractionated or Low-Molecular Weight Heparin: A Cohort Study in the Context of a Quality Improvement Initiative. Annals of Pharmacotherapy. 2010;44(6):994-1002. doi:https://doi.org/10.1345/aph.1m615
60. Prandoni P. The incidence of heparin-induced thrombocytopenia in medical patients treated with low-molecular-weight heparin: a prospective cohort study. Blood. 2005;106(9):3049-3054. doi:https://doi.org/10.1182/blood-2005-03-0912
61. Pizov R. Subcutaneous Fondaparinux Versus Intravenous Unfractionated Heparin in the Initial Treatment of Pulmonary Embolism. Survey of Anesthesiology. 2004;48(4):173-174. doi:https://doi.org/10.1097/01.sa.0000131997.94738.a2
62. Hirsh J, Raschke R. Heparin and Low-Molecular-Weight Heparin. Chest. 2004;126(3):188S203S. doi:https://doi.org/10.1378/chest.126.3_suppl.188s
63. Turpie AGG, Eriksson BI, Lassen MR, Bauer KA. Fondaparinux, the first selective factor Xa inhibitor. Current Opinion in Hematology. 2003;10(5):327-332. doi:https://doi.org/10.1097/00062752-200309000-00001
64. Ucar EY, Araz O, Akgun M, et al. Low-Molecular-Weight Heparin Use with Thrombolysis: Is it Effective and Safe? Ten Years’ Clinical Experience. Respiration. 2013;86(4):318-323. doi:https://doi.org/10.1159/000346203
65. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmau_rice D, Galiè N, Gibbs JSR, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Noordegraaf AV, Zamorano JL, Zompatori M, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol Ç, Fagard R, Agewall S, Asteggiano R, Bauersachs R, Becattini C, Bounameaux H, Büller HR, Davos CH, Geersing GJ, Sanchez MAG, Hendriks J, Kilickap M, Mareev V, Monreal M, Morais J, Popescu BA, Sanchez O, Spy_ropoulos AC, (2014) 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35: 3033–3080.
66. Engelberger RP, Kucher N. Catheter-Based Reperfusion Treatment of Pulmonary Embolism. Circulation. 2011;124(19):2139-2144. doi:https://doi.org/10.1161/circulationaha.111.023689
67. Kucher N. Catheter Embolectomy for Acute Pulmonary Embolism. Chest. 2007;132(2):657-663. doi:https://doi.org/10.1378/chest.07-0665
68. Achkar A, Horellou MH ., Parent F, et al. Le traitement antithrombotique de la maladie thromboembolique veineuse. Revue des Maladies Respiratoires. 2005;22(5):833-835. doi:https://doi.org/10.1016/s0761-8425(05)85645-1
69. FARGE D, DEBOURDEAU P, BECKERS M, et al. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Journal of Thrombosis and Haemostasis. 2013;11(1):56-70. doi:https://doi.org/10.1111/jth.12070