Pulmonary embolism in patients with severe COVID-19 treated with intermediate- to full-dose enoxaparin: A retrospective study

Submitted: January 2, 2021
Accepted: March 4, 2021
Published: March 16, 2021
Abstract Views: 2103
PDF: 869
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


Coronavirus disease (COVID-19) may predispose patients to pulmonary embolism (PE), despite standard thromboprophylaxis. Our retrospective study aimed to report the prevalence of PE in patients with COVID-19 and severe respiratory failure (SRF) treated with intermediate- to full-dose enoxaparin. We analyzed data from patients with COVID-19 pneumonia and SRF admitted to our Respiratory Intensive Care Unit (RICU) from February 27 to April 20, 2020. All patients received at least intermediate-dose enoxaparin (40 mg twice daily). Computed tomography pulmonary angiography (CTPA) was used to detect PE. Ninety-two patients with COVID-19 pneumonia and SRF were admitted to our RICU. Twenty-two patients underwent CTPA (24 %), 11 of whom had PEs (12%). We hypothesize that the enoxaparin treatment may be responsible for the lower prevalence of PE as compared to previous reports of similar patients, even if our report had several limitations, mainly the small sample size.



PlumX Metrics


Download data is not yet available.


Guan WJ, Ni ZY, Yu H, et al. China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Eng J Med 2020;382:1708–1720. DOI: https://doi.org/10.1056/NEJMoa2002032
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506. DOI: https://doi.org/10.1016/S0140-6736(20)30183-5
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507–513. DOI: https://doi.org/10.1016/S0140-6736(20)30211-7
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061–1069. DOI: https://doi.org/10.1001/jama.2020.1585
Ministero Della Salute. Covid-19, i casi in Italia il 18 dicembre: situazione Italia al 18 Dicembre. Accessed December 18 2020. http://www.salute.gov.it/portale/nuovocoronavirus/dettaglioNotizieNuovoCoronavirus.jsp?lingua=italiano&menu=notizie&p=dalministero&id=4539
Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020;18:844–847. DOI: https://doi.org/10.1111/jth.14768
Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020;18:1094–1099. DOI: https://doi.org/10.1111/jth.14817
Zhang Y, Xiao M, Zhang S, et al. Coagulopathy and antiphospholipid antibodies in patients with Covid-19. N Eng J Med. 2020;382:e38. DOI: https://doi.org/10.1056/NEJMc2007575
Klok FA, Kruip MJ, Van der Meer NJ, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020;191:145–7. DOI: https://doi.org/10.1016/j.thromres.2020.04.013
Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020;18:1421–24. DOI: https://doi.org/10.1111/jth.14830
Piazza G, Campia U, Hurwitz S, et al. Registry of arterial and venous thromboembolic complications in patients with COVID-19. JACC 2020;76:2060–72. DOI: https://doi.org/10.1016/j.jacc.2020.08.070
Poissy J, Goutay J, Caplan M, et al; Lille ICU Haemostasis COVID-19 Group. Pulmonary embolism in COVID-19 patients: awareness of an increased prevalence. Circulation. 2020;142:184–6. DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.047430
Lodigiani C, Iapichino G, Carenzo L, et al; Humanitas COVID-19 Task Force. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020;191:9–14. DOI: https://doi.org/10.1016/j.thromres.2020.04.024
World Health Organization. Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases: interim guidance. Accessed 10 August 2020. https://www.who.int/publications/i/item/10665-331501
Kresoja KP, Ebner M, Rogge NI, et al. Prediction and prognostic importance of in-hospital major bleeding in a real-world cohort of patients with pulmonary embolism. Int J Cardiol. 2019;290:144–9. DOI: https://doi.org/10.1016/j.ijcard.2019.03.017
Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020;71:762–8. DOI: https://doi.org/10.1093/cid/ciaa248
Ackermann M, Verleden SE, Kuehnel M, et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in COVID-19. N Eng J Med 2020;383:120–8. DOI: https://doi.org/10.1056/NEJMoa2015432
Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endothelitis in COVID-19. Lancet 2020;395:417–8. DOI: https://doi.org/10.1016/S0140-6736(20)30937-5
Wichmann D, Sperhake JP, Lutgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID-19. Ann Intern Med 2020;173:268–7. DOI: https://doi.org/10.7326/M20-2003
Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and thrombotic and thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC State-of-the-art review. J Am Coll Cardiol 2020;75:2950–73. DOI: https://doi.org/10.1016/j.jacc.2020.04.031
Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307:2526–33.
Simonnet A, Chetboun M, Poissy J, et al; the LICORN and the Lille COVID-19 and Obesity Study Group. High prevalence of obesity in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring) 2020;28:1195–9. DOI: https://doi.org/10.1002/oby.22831
British Thoracic Society. BTS Guidance on venous thromboembolic disease in patients with COVID-19. Accessed 10 August 2020. https://brit-thoracic.org.uk/document-library/quality-improvement/covid-19/bts-guidance-on-venous-thromboembolic-disease-in-patients-with-covid-19
Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020;41:543-603. DOI: https://doi.org/10.1093/eurheartj/ehz405
National Institutes of Health (NIH). Coronavirus disease 2019 (COVID-19) treatment guidelines. Accessed December 12, 2020. https://www.covid19treatmentguidelines.nih.gov/

Ethics Approval

This study was approved by the Valpadana ATS (Cremona, Italy) Ethics Committee on 7 July 2020 (Study code 95-2020-OSS_FARM-MN30), Institutional approval: This study was approved by the ASST Mantova on 20 August 2020 (deliberation N° 1043)

How to Cite

Scarduelli, Cleante, Francesco Inglese, Massimiliano Beccaria, Fabio Spreafico, Martina Garuti, Antonietta Pecoriello, Giulia Cervi, Graziana Greco, Sara Scarduelli, Giuseppe Lucchini, Giuseppe De Donno, and Claudio Borghi. 2021. “Pulmonary Embolism in Patients With Severe COVID-19 Treated With Intermediate- to Full-Dose Enoxaparin: A Retrospective Study”. Monaldi Archives for Chest Disease 91 (3). https://doi.org/10.4081/monaldi.2021.1758.