Pulmonary thrombosis associated with COVID‐19 pneumonia: Beyond classical pulmonary thromboembolism
Background Classical pulmonary thromboembolism (TE) and local pulmonary thrombosis (PT) have been suggested as mechanisms of thrombosis in COVID‐19. However, robust evidence is still lacking because this was mainly based on retrospective studies, in which patients were included when TE was suspected...
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| Veröffentlicht in: | European journal of clinical investigation 2024-06, Vol.54 (6), p.e14176-n/a |
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| creator | Suárez‐Castillejo, Carla Calvo, Néstor Preda, Luminita Toledo‐Pons, Nuria Millán‐Pons, Aina Rosa Martínez, Joaquín Ramón, Luisa Iglesias, Amanda Morell‐García, Daniel Bauça, Josep Miquel Núñez, Belén Sauleda, Jaume Sala‐Llinas, Ernest Alonso‐Fernández, Alberto |
| description | Background
Classical pulmonary thromboembolism (TE) and local pulmonary thrombosis (PT) have been suggested as mechanisms of thrombosis in COVID‐19. However, robust evidence is still lacking because this was mainly based on retrospective studies, in which patients were included when TE was suspected.
Methods
All patients with COVID‐19 pneumonia underwent computed tomography and pulmonary angiography in a prospective study. The main objective was to determine the number and percentage of thrombi surrounded by lung opacification (TSO) in each patient, as well as their relationship with percentage of lung involvement (TLI), to distinguish classical TE (with a random location of thrombi that should correspond to a percentage of TSO equivalent to the TLI) from PT. We determined TLI by artificial intelligence. Analyses at patient level (TLI and percentage of TSO) and at thrombi level (TLI and TSO) were performed.
Results
We diagnosed TE in 70 out of 184 patients. Three (2–8) thrombi/patient were detected. The percentage of TSO was 100% (75–100) per patient, and TLI was 19.9% (4.6–35.2). Sixty‐five patients (92.9%) were above the random scenario with higher percentage of TSO than TLI. Most thrombi were TSO (n = 299, 75.1%). When evaluating by TLI (30%), percentage of TSO was higher in most groups. Thrombi were mainly in subsegmental/segmental arteries, and percentage of TSO was higher in all locations.
Conclusions
Thrombi in COVID‐19 were found within lung opacities in a higher percentage than lung involvement, regardless of TLI and clot location, supporting the hypothesis of local PT rather than “classic TE”.
Pulmonary thrombosis is quite frequent in COVID‐19, but mechanisms still remain unclear. This study investigates whether pulmonary thrombi are located within lung opacification areas. Thrombi in COVID‐19 pneumonia complicated with PT were found within lung opacities in a higher percentage than lung involvement, regardless of the proportion of pulmonary infiltrates and clot location. COVID‐19 could promote local lung pro‐thrombotic phenomena rather than classic thromboembolism. These data expand understanding of PT in COVID‐19 and support a partial justification for why thromboprophylaxis may not prevent PT. |
| doi_str_mv | 10.1111/eci.14176 |
| format | Article |
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Classical pulmonary thromboembolism (TE) and local pulmonary thrombosis (PT) have been suggested as mechanisms of thrombosis in COVID‐19. However, robust evidence is still lacking because this was mainly based on retrospective studies, in which patients were included when TE was suspected.
Methods
All patients with COVID‐19 pneumonia underwent computed tomography and pulmonary angiography in a prospective study. The main objective was to determine the number and percentage of thrombi surrounded by lung opacification (TSO) in each patient, as well as their relationship with percentage of lung involvement (TLI), to distinguish classical TE (with a random location of thrombi that should correspond to a percentage of TSO equivalent to the TLI) from PT. We determined TLI by artificial intelligence. Analyses at patient level (TLI and percentage of TSO) and at thrombi level (TLI and TSO) were performed.
Results
We diagnosed TE in 70 out of 184 patients. Three (2–8) thrombi/patient were detected. The percentage of TSO was 100% (75–100) per patient, and TLI was 19.9% (4.6–35.2). Sixty‐five patients (92.9%) were above the random scenario with higher percentage of TSO than TLI. Most thrombi were TSO (n = 299, 75.1%). When evaluating by TLI (<10%, 10%–20%, 20%–30% and >30%), percentage of TSO was higher in most groups. Thrombi were mainly in subsegmental/segmental arteries, and percentage of TSO was higher in all locations.
Conclusions
Thrombi in COVID‐19 were found within lung opacities in a higher percentage than lung involvement, regardless of TLI and clot location, supporting the hypothesis of local PT rather than “classic TE”.
Pulmonary thrombosis is quite frequent in COVID‐19, but mechanisms still remain unclear. This study investigates whether pulmonary thrombi are located within lung opacification areas. Thrombi in COVID‐19 pneumonia complicated with PT were found within lung opacities in a higher percentage than lung involvement, regardless of the proportion of pulmonary infiltrates and clot location. COVID‐19 could promote local lung pro‐thrombotic phenomena rather than classic thromboembolism. These data expand understanding of PT in COVID‐19 and support a partial justification for why thromboprophylaxis may not prevent PT.</description><identifier>ISSN: 0014-2972</identifier><identifier>EISSN: 1365-2362</identifier><identifier>DOI: 10.1111/eci.14176</identifier><identifier>PMID: 38339827</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Angiography ; Arteries ; Artificial intelligence ; Computed tomography ; Computed Tomography Angiography ; COVID-19 ; COVID-19 - complications ; COVID-19 - diagnostic imaging ; Female ; Humans ; Lung - diagnostic imaging ; Lungs ; Male ; Middle Aged ; Patients ; Pneumonia ; prospective ; Prospective Studies ; pulmonary embolism ; Pulmonary Embolism - diagnostic imaging ; Pumonary thrombosis ; SARS-CoV-2 ; Thromboembolism ; Thrombosis ; Thrombosis - diagnostic imaging ; Tomography, X-Ray Computed</subject><ispartof>European journal of clinical investigation, 2024-06, Vol.54 (6), p.e14176-n/a</ispartof><rights>2024 The Authors. published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.</rights><rights>2024 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.</rights><rights>2024. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3886-7ed579389906794e7f81478f2497289b93bf38c087cfda8838d0284a094fd6603</citedby><cites>FETCH-LOGICAL-c3886-7ed579389906794e7f81478f2497289b93bf38c087cfda8838d0284a094fd6603</cites><orcidid>0000-0001-8383-0437</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Feci.14176$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Feci.14176$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38339827$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Suárez‐Castillejo, Carla</creatorcontrib><creatorcontrib>Calvo, Néstor</creatorcontrib><creatorcontrib>Preda, Luminita</creatorcontrib><creatorcontrib>Toledo‐Pons, Nuria</creatorcontrib><creatorcontrib>Millán‐Pons, Aina Rosa</creatorcontrib><creatorcontrib>Martínez, Joaquín</creatorcontrib><creatorcontrib>Ramón, Luisa</creatorcontrib><creatorcontrib>Iglesias, Amanda</creatorcontrib><creatorcontrib>Morell‐García, Daniel</creatorcontrib><creatorcontrib>Bauça, Josep Miquel</creatorcontrib><creatorcontrib>Núñez, Belén</creatorcontrib><creatorcontrib>Sauleda, Jaume</creatorcontrib><creatorcontrib>Sala‐Llinas, Ernest</creatorcontrib><creatorcontrib>Alonso‐Fernández, Alberto</creatorcontrib><title>Pulmonary thrombosis associated with COVID‐19 pneumonia: Beyond classical pulmonary thromboembolism</title><title>European journal of clinical investigation</title><addtitle>Eur J Clin Invest</addtitle><description>Background
Classical pulmonary thromboembolism (TE) and local pulmonary thrombosis (PT) have been suggested as mechanisms of thrombosis in COVID‐19. However, robust evidence is still lacking because this was mainly based on retrospective studies, in which patients were included when TE was suspected.
Methods
All patients with COVID‐19 pneumonia underwent computed tomography and pulmonary angiography in a prospective study. The main objective was to determine the number and percentage of thrombi surrounded by lung opacification (TSO) in each patient, as well as their relationship with percentage of lung involvement (TLI), to distinguish classical TE (with a random location of thrombi that should correspond to a percentage of TSO equivalent to the TLI) from PT. We determined TLI by artificial intelligence. Analyses at patient level (TLI and percentage of TSO) and at thrombi level (TLI and TSO) were performed.
Results
We diagnosed TE in 70 out of 184 patients. Three (2–8) thrombi/patient were detected. The percentage of TSO was 100% (75–100) per patient, and TLI was 19.9% (4.6–35.2). Sixty‐five patients (92.9%) were above the random scenario with higher percentage of TSO than TLI. Most thrombi were TSO (n = 299, 75.1%). When evaluating by TLI (<10%, 10%–20%, 20%–30% and >30%), percentage of TSO was higher in most groups. Thrombi were mainly in subsegmental/segmental arteries, and percentage of TSO was higher in all locations.
Conclusions
Thrombi in COVID‐19 were found within lung opacities in a higher percentage than lung involvement, regardless of TLI and clot location, supporting the hypothesis of local PT rather than “classic TE”.
Pulmonary thrombosis is quite frequent in COVID‐19, but mechanisms still remain unclear. This study investigates whether pulmonary thrombi are located within lung opacification areas. Thrombi in COVID‐19 pneumonia complicated with PT were found within lung opacities in a higher percentage than lung involvement, regardless of the proportion of pulmonary infiltrates and clot location. COVID‐19 could promote local lung pro‐thrombotic phenomena rather than classic thromboembolism. These data expand understanding of PT in COVID‐19 and support a partial justification for why thromboprophylaxis may not prevent PT.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angiography</subject><subject>Arteries</subject><subject>Artificial intelligence</subject><subject>Computed tomography</subject><subject>Computed Tomography Angiography</subject><subject>COVID-19</subject><subject>COVID-19 - complications</subject><subject>COVID-19 - diagnostic imaging</subject><subject>Female</subject><subject>Humans</subject><subject>Lung - diagnostic imaging</subject><subject>Lungs</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Pneumonia</subject><subject>prospective</subject><subject>Prospective Studies</subject><subject>pulmonary embolism</subject><subject>Pulmonary Embolism - diagnostic imaging</subject><subject>Pumonary thrombosis</subject><subject>SARS-CoV-2</subject><subject>Thromboembolism</subject><subject>Thrombosis</subject><subject>Thrombosis - diagnostic imaging</subject><subject>Tomography, X-Ray Computed</subject><issn>0014-2972</issn><issn>1365-2362</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kM1KAzEQx4MotlYPvoAseNHD2nw1H950rVoo1IN6DWk2S1N2N3XTpfTmI_iMPonRVg8FB4a5_ObHzB-AUwSvUKy-Ne4KUcTZHugiwgYpJgzvgy6EiKZYctwBRyHMIYQCEXwIOkQQIgXmXWCf2rLytW7WyXLW-GrqgwuJDsEbp5c2T1ZuOUuyyevo7vP9A8lkUds2Ljh9ndzata_zxJQRd0aXyWLXZWOXLlTH4KDQZbAn29kDL_fD5-wxHU8eRtnNODVECJZymw-4JEJKyLiklhcCUS4KTOMPQk4lmRZEGCi4KXItBBE5xIJqKGmRMwZJD1xsvIvGv7U2LFXlgrFlqWvr26CwjCrJKWIRPd9B575t6nidInBACYOYkkhdbijT-BAaW6hF46r4oUJQfWevYvbqJ_vInm2N7bSy-R_5G3YE-htg5Uq7_t-khtloo_wCxG-NoQ</recordid><startdate>202406</startdate><enddate>202406</enddate><creator>Suárez‐Castillejo, Carla</creator><creator>Calvo, Néstor</creator><creator>Preda, Luminita</creator><creator>Toledo‐Pons, Nuria</creator><creator>Millán‐Pons, Aina Rosa</creator><creator>Martínez, Joaquín</creator><creator>Ramón, Luisa</creator><creator>Iglesias, Amanda</creator><creator>Morell‐García, Daniel</creator><creator>Bauça, Josep Miquel</creator><creator>Núñez, Belén</creator><creator>Sauleda, Jaume</creator><creator>Sala‐Llinas, Ernest</creator><creator>Alonso‐Fernández, Alberto</creator><general>Blackwell Publishing Ltd</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-8383-0437</orcidid></search><sort><creationdate>202406</creationdate><title>Pulmonary thrombosis associated with COVID‐19 pneumonia: Beyond classical pulmonary thromboembolism</title><author>Suárez‐Castillejo, Carla ; Calvo, Néstor ; Preda, Luminita ; Toledo‐Pons, Nuria ; Millán‐Pons, Aina Rosa ; Martínez, Joaquín ; Ramón, Luisa ; Iglesias, Amanda ; Morell‐García, Daniel ; Bauça, Josep Miquel ; Núñez, Belén ; Sauleda, Jaume ; Sala‐Llinas, Ernest ; Alonso‐Fernández, Alberto</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3886-7ed579389906794e7f81478f2497289b93bf38c087cfda8838d0284a094fd6603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angiography</topic><topic>Arteries</topic><topic>Artificial intelligence</topic><topic>Computed tomography</topic><topic>Computed Tomography Angiography</topic><topic>COVID-19</topic><topic>COVID-19 - complications</topic><topic>COVID-19 - diagnostic imaging</topic><topic>Female</topic><topic>Humans</topic><topic>Lung - diagnostic imaging</topic><topic>Lungs</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Pneumonia</topic><topic>prospective</topic><topic>Prospective Studies</topic><topic>pulmonary embolism</topic><topic>Pulmonary Embolism - diagnostic imaging</topic><topic>Pumonary thrombosis</topic><topic>SARS-CoV-2</topic><topic>Thromboembolism</topic><topic>Thrombosis</topic><topic>Thrombosis - diagnostic imaging</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Suárez‐Castillejo, Carla</creatorcontrib><creatorcontrib>Calvo, Néstor</creatorcontrib><creatorcontrib>Preda, Luminita</creatorcontrib><creatorcontrib>Toledo‐Pons, Nuria</creatorcontrib><creatorcontrib>Millán‐Pons, Aina Rosa</creatorcontrib><creatorcontrib>Martínez, Joaquín</creatorcontrib><creatorcontrib>Ramón, Luisa</creatorcontrib><creatorcontrib>Iglesias, Amanda</creatorcontrib><creatorcontrib>Morell‐García, Daniel</creatorcontrib><creatorcontrib>Bauça, Josep Miquel</creatorcontrib><creatorcontrib>Núñez, Belén</creatorcontrib><creatorcontrib>Sauleda, Jaume</creatorcontrib><creatorcontrib>Sala‐Llinas, Ernest</creatorcontrib><creatorcontrib>Alonso‐Fernández, Alberto</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of clinical investigation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Suárez‐Castillejo, Carla</au><au>Calvo, Néstor</au><au>Preda, Luminita</au><au>Toledo‐Pons, Nuria</au><au>Millán‐Pons, Aina Rosa</au><au>Martínez, Joaquín</au><au>Ramón, Luisa</au><au>Iglesias, Amanda</au><au>Morell‐García, Daniel</au><au>Bauça, Josep Miquel</au><au>Núñez, Belén</au><au>Sauleda, Jaume</au><au>Sala‐Llinas, Ernest</au><au>Alonso‐Fernández, Alberto</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pulmonary thrombosis associated with COVID‐19 pneumonia: Beyond classical pulmonary thromboembolism</atitle><jtitle>European journal of clinical investigation</jtitle><addtitle>Eur J Clin Invest</addtitle><date>2024-06</date><risdate>2024</risdate><volume>54</volume><issue>6</issue><spage>e14176</spage><epage>n/a</epage><pages>e14176-n/a</pages><issn>0014-2972</issn><eissn>1365-2362</eissn><abstract>Background
Classical pulmonary thromboembolism (TE) and local pulmonary thrombosis (PT) have been suggested as mechanisms of thrombosis in COVID‐19. However, robust evidence is still lacking because this was mainly based on retrospective studies, in which patients were included when TE was suspected.
Methods
All patients with COVID‐19 pneumonia underwent computed tomography and pulmonary angiography in a prospective study. The main objective was to determine the number and percentage of thrombi surrounded by lung opacification (TSO) in each patient, as well as their relationship with percentage of lung involvement (TLI), to distinguish classical TE (with a random location of thrombi that should correspond to a percentage of TSO equivalent to the TLI) from PT. We determined TLI by artificial intelligence. Analyses at patient level (TLI and percentage of TSO) and at thrombi level (TLI and TSO) were performed.
Results
We diagnosed TE in 70 out of 184 patients. Three (2–8) thrombi/patient were detected. The percentage of TSO was 100% (75–100) per patient, and TLI was 19.9% (4.6–35.2). Sixty‐five patients (92.9%) were above the random scenario with higher percentage of TSO than TLI. Most thrombi were TSO (n = 299, 75.1%). When evaluating by TLI (<10%, 10%–20%, 20%–30% and >30%), percentage of TSO was higher in most groups. Thrombi were mainly in subsegmental/segmental arteries, and percentage of TSO was higher in all locations.
Conclusions
Thrombi in COVID‐19 were found within lung opacities in a higher percentage than lung involvement, regardless of TLI and clot location, supporting the hypothesis of local PT rather than “classic TE”.
Pulmonary thrombosis is quite frequent in COVID‐19, but mechanisms still remain unclear. This study investigates whether pulmonary thrombi are located within lung opacification areas. Thrombi in COVID‐19 pneumonia complicated with PT were found within lung opacities in a higher percentage than lung involvement, regardless of the proportion of pulmonary infiltrates and clot location. COVID‐19 could promote local lung pro‐thrombotic phenomena rather than classic thromboembolism. These data expand understanding of PT in COVID‐19 and support a partial justification for why thromboprophylaxis may not prevent PT.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>38339827</pmid><doi>10.1111/eci.14176</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0001-8383-0437</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of clinical investigation, 2024-06, Vol.54 (6), p.e14176-n/a |
| issn | 0014-2972 1365-2362 |
| language | eng |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Aged Aged, 80 and over Angiography Arteries Artificial intelligence Computed tomography Computed Tomography Angiography COVID-19 COVID-19 - complications COVID-19 - diagnostic imaging Female Humans Lung - diagnostic imaging Lungs Male Middle Aged Patients Pneumonia prospective Prospective Studies pulmonary embolism Pulmonary Embolism - diagnostic imaging Pumonary thrombosis SARS-CoV-2 Thromboembolism Thrombosis Thrombosis - diagnostic imaging Tomography, X-Ray Computed |
| title | Pulmonary thrombosis associated with COVID‐19 pneumonia: Beyond classical pulmonary thromboembolism |
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