Early diagnosis of pulmonary embolism could enhance treatment in COVID-19 patients

Researchers at Henry Ford Health System in Detroit say early diagnosis of a life-threatening blood clot in the lungs led to swifter treatment intervention in COVID-19 patients.

In a new study published recently in the journal Radiology, researchers found that 51 percent of patients found to have a pulmonary embolism, or PE, were diagnosed in the Emergency Department, the entry point for patients being admitted to the hospital.

In Europe, research has shown that most cases of PE were diagnosed in patients admitted to the intensive care unit after being on a ventilator for several days.

In the Henry Ford study, researchers say 72 percent of PE diagnoses were in patients who did not require "ICU-level care," suggesting that timely diagnosis and use of blood thinners could have played a role in the treatment process.

Based on our study, early detection of PE could further enhance and optimize treatment for patients first presenting in the Emergency Department. We advise clinicians to think of PE as an additional complication early on during the admission of patients whose symptoms and lab results point to that condition."

Pallavi Bhargava, M.D., infectious diseases physician involved in the study

Thomas Song, M.D., a radiologist and the study's senior author, says a timely pulmonary CT angiography made the difference in the PE diagnosis. "We recommend CT angiography because a traditional CT scan may not pick up the blood clot," Dr. Song says.

In addition to the early detection finding, other key highlights emerged from the retrospective study of 328 COVID-19 patients who underwent a pulmonary CT angiography between March 16 and April 18 at Henry Ford's acute care hospitals:

• 22 percent of patients were found to have a pulmonary embolism.

• Patients with a BMI (body mass index) of 30 or higher are nearly three times more at risk for developing a pulmonary embolism. The ideal BMI for adults is 18.5 – 24.9.

• Patients on statin therapy prior to admission were less likely to develop a pulmonary embolism.

• Increased D-dimer and C-reactive protein lab markers, in conjunction with a rising oxygen requirement, may be a predictor of a pulmonary embolism, even when patients are receiving preventive blood thinners.

"Our findings suggest that patients who test positive for COVID-19 should be started on preventive blood thinners early on in their treatment and that the need for CT angiography be assessed on a case by case basis to look for blood clots," Dr. Bhargava says. "Our ER doctors played a key role in meticulously assessing these patients, evaluating their d-dimer marker value and ordering the right CT scans to identify these blood clots so early in the diagnosis."