Pulmonary embolism in a patient with viral pneumonia: COVID-19 or H1N1 influenza: two case reports
https://doi.org/10.15829/1560-4071-2024-5821
EDN: XJIBUV
Abstract
The article presents two case reports of pulmonary embolism in patients with viral pneumonia. In one case, in a coronavirus disease 2019 (COVID-19) survivor, while in the second case — in a patient with influenza. A comparative analysis of thromboembolism characteristics in two patients is consistent with the literature data and confirms the differences in its predictors and the different clinical picture. Pulmonary embolism is becoming an increasingly relevant disease for cardiologists. The importance of understanding the risk factors for pulmonary embolism and clinical picture aspects in patients with viral pneumonia in the current epidemiological situation with both a COVID-19 and seasonal pathogens, including the influenza virus, is emphasized.
About the Authors
S. K. KononovRussian Federation
Sergei K. Kononov — PhD, chief of cardiology department
Kirov
O. V. Solovev
Russian Federation
Oleg V. Solovev — Professor, chief of internal medicine department
Kirov
I. S. Metelev
Russian Federation
Ilya S. Metelev — PhD, cardiologist
Kirov
D. E. Nazarov
Russian Federation
Dmitry E. Nazarov — PhD, chief of reanimatology department
Kirov
A. V. Pshenichnikova
Russian Federation
Anastasia V. Pshenichnikova — Echocardiographer
Kirov
D. A. Khomyakov
Russian Federation
Dmitry A. Khomyakov — Cardiologist
Kirov
References
1. Xu F, Xi L, Tao Y, et al. Risk factors for venous thromboembolism in patients with pneumonia in the pre-COVID-19 era: a meta-analysis and systematic review. J Thorac Dis. 2023;15(12):6697-707. doi:10.21037/jtd-23-926.
2. Al-Ani F, Chehade S, Lazo-Langner A. Thrombosis risk associated with COVID-19 infection. A scoping review Thrombosis Research. 2020;192:152-60. doi:10.1016/j.thromres.2020.05.039.
3. Xu J-F, Wang L, Zhao L, et al. Risk Assessment of Venous Thromboembolism and Bleeding in COVID-19 Patients. Research Square. 2020. doi:10.1111/crj.13467.
4. Bhoelan S, Codreanu C, Tichelaar V, et al. Exploring heterogeneity in reported venous thromboembolism risk in COVID-19 and comparison to other viral pneumonias: a systematic review and meta-regression. Res Pract Thromb Haemost. 2023;7(5):102146. doi:10.1016/j.rpth.2023.102146.
5. Helms J, Tacquard C, Severac F, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020;46(6):1089-98. doi:10.1007/s00134-020-06062-x.
6. Honkanen M, Sirkeoja S, Viskari H, et al. Risk of venous thromboembolism in COVID-19 infection. Intern Med J. 2023;53(8):1478-80. doi:10.1111/imj.16145.
7. Burn E, Duarte-Salles T, Fernandez-Bertolin S, et al. Venous or arterial thrombosis and deaths among COVID-19 cases: a European network cohort study. Lancet Infect Dis. 2022;22(8):1142-52. doi:10.1016/S1473-3099(22)00223-7.
8. Miró Ò, González Del Castillo J.Collaboration among Spanish emergency departments to promote research: on the creation of the SIESTA (Spanish Investigators in Emergency Situations TeAm) network and the coordination of the UMC-19 (Unusual Manifestations of COVID-19) macroproject. Emergencias. 2020;32(4):269-77.
9. Miró Ò, Jiménez S, Mebazaa A, et al. Spanish Investigators on Emergency Situations TeAm (SIESTA) network. Pulmonary embolism in patients with COVID-19: incidence, risk factors, clinical characteristics, and outcome. Eur Heart J. 2021;42(33):3127-42. doi:10.1093/eurheartj/ehab314.
10. Lee SY, Teo WZY, Lim CXQ, et al. Venous thromboembolism in an Asian COVID-19 cohort across 3 infection waves-a retrospective observational study. Res Pract Thromb Haemost. 2023;7(7):102218. doi:10.1016/j.rpth.2023.102218.
11. Fauvel C, Weizman O, Trimaille A, et al. Critical Covid-19 France Investigators. Pulmonary embolism in COVID-19 patients: a French multicentre cohort study. Eur Heart J. 2020;41(32):3058-68. doi:10.1093/eurheartj/ehaa500.
12. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135(2):98-107. doi:10.7326/0003-4819-135-2-200107170-00010.
13. Tan BK, Mainbourg S, Friggeri A, et al. Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis. Thorax. 2021;76:970-9. doi:10.1136/thoraxjnl2020-215383.
14. Kononov SK, Solovev OV, Kraev AR, et al. Clinical features of pulmonary embolism in patients with previous recent COVID-19 infection. Russian Medicine. 2023;29(6):455-66. (In Russ.) doi:10.17816/medjrf583009.
15. Kraev AR, Solov'ev OV, Kononov SK, Ralnikova UA. Thrombotic complications in postcovid patienтs. Medical newsletter of Vyatka. 2023;(2). (In Russ.) doi:10.24412/2220-7880-2023-2-26-31.
16. Wichmann D, Sperhake JP, Lutgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID-19. Ann Intern Med. 2020;173(4). doi:10.7326/M20-2003.
17. Manolis AS, Manolis TA, Manolis AA, et al. COVID-19 Infection: Viral Macro- and MicroVascular Coagulopathy and Thromboembolism/Prophylactic and Therapeutic Management. J Cardiovasc Pharmacol Ther. 2021;26(1):12-24. doi:10.1177/1074248420958973.
18. Kho J, Ioannou A, Van den Abbeele K, et al. Pulmonary embolism in COVID-19: Clinical characteristics and cardiac implications. Am J Emerg Med. 2020;38(10):2142-6. doi:10.1016/j.ajem.2020.07.054.
19. Hariri LP, North CM, Shih AR, et al. Lung Histopathology in Coronavirus Disease 2019 as Compared With Severe Acute Respiratory Sydrome and H1N1 Influenza: A Systematic Review. Chest. 2021;159(1):73-84. doi:10.1016/j.chest.2020.09.259.
20. Muñoz OM, Ruiz-Talero P, Hernández-Florez C, et al. Validation of the PESI Scale to Predict in-Hospital Mortality in Patients with Pulmonary Thromboembolism Secondary to SARS CoV-2 Infection. Clin Appl Thromb Hemost. 2022;28:10760296221102940. doi:10.1177/10760296221102940.
21. LaRussa P. Pandemic novel 2009 H1N1 influenza: what have we learned? Semin Respir Crit Care Med. 2011;32:393-99. doi:10.1055/s-0031-1283279.
22. Vinod L Pal, Dharani M, Utpat K, et al. Pulmonary Thromboembolism and Pulmonary Fibrosis due to H1N1 Pneumonia with Acute Respiratory Distress Syndrome: Not ALL is COVID. J.Gastroenterology ancreatology and Hepatobilary Disorders. 2021;5(4). doi:10.31579/2641-5194/035.
23. Obi AT, Tignanelli CJ, Jacobs BN, et al. Empirical systemic anticoagulation is associated with decreased venous thromboembolism in critically ill influenza A H1N1 acute respiratory distress syndrome patients. J Vasc Surg Venous Lymphat Disord. 2019;7(3):317-24. doi:10.1016/j.jvsv.2018.08.010.
24. Dimakakos E, Grapsa D, Vathiotis I, et al. H1N1-Induced Venous Thromboembolic Events? Results of a Single-Institution Case Series. Open Forum Infect Dis. 2016;3(4): ofw214. doi:10.1093/ofid/ofw214.
25. Miesbach W, Makris M. COVID-19: Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation. Clin Appl Thromb Hemost. 2020;26:1076029620938149. doi:10.1177/1076029620938149.
26. Jenner WJ, Kanji R, Mirsadraee S, et al. Thrombotic complications in 2928 patients with COVID-19 treated in intensive care: a systematic review. J Thromb Thrombolysis. 2021;51(3):595-607. doi:10.1007/s11239-021-02394-7.
27. Ermerak NO, Yildizeli SO, Kocakaya D, et al. Surgical treatment of another sequalae of COVID-19: post-COVID CTEPH. Thorac Cardiovasc Surg. 2023;71(5):413-7. doi:10.1055/a-2059-4513.
28. Franco-Moreno A, Brown-Lavalle D, Campos-Arenas M, et al. Acute phase characteristics and long-term complications of pulmonary embolism in COVID-19 compared to non-COVID-19 cohort: a large single-centre study. BMC Pulm Med. 2023;23(1):25. doi:10.1186/s12890-023-02323-9.
Supplementary files
- Patients with moderate COVID-19 are at increased risk of pulmonary embolism.
- Severe course of H1N1 influenza is also associated with an increased thromboembolism risk.
- There are features in risk factors, clinical performance of pulmonary embolism and prognosis in patients with viral pneumonia of various origins.
- We have summarized the analyzed literature data; this will be useful in practice for doctors of all specialties, especially cardiologists.
Review
For citations:
Kononov S.K., Solovev O.V., Metelev I.S., Nazarov D.E., Pshenichnikova A.V., Khomyakov D.A. Pulmonary embolism in a patient with viral pneumonia: COVID-19 or H1N1 influenza: two case reports. Russian Journal of Cardiology. 2024;29(3S):5821. (In Russ.) https://doi.org/10.15829/1560-4071-2024-5821. EDN: XJIBUV