(With regular inputs from Dr Monica Vasudev)

A special report published in the journal Radiology outlines prevention, diagnosis and treatment of venous thromboembolism (VTE) in patients with COVID-19 

From the analysis of available medical, laboratory, and imaging data on COVID-19, it has become quite clear that symptoms and diagnostic tests could not be explained by impaired pulmonary ventilation alone.

Recent observations have pointed that respiratory failure in COVID-19 is not guided by the development of acute respiratory distress syndrome alone. Microvascular thrombotic processes may also play a role. This could perhaps have important consequences for the diagnostic and therapeutic management of these patients. A strong association has been noted between D-dimer levels, disease progression, and chest CT features suggesting venous thrombosis. Several studies in patients with COVID-19 have also shown a robust link between increased D-dimer levels and severe disease/poor prognosis.

Imaging and pathological investigations confirmed the COVID-19 syndrome is a thrombo-inflammatory process that initially affects lung perfusion, and consecutively goes on to affect all organs of the body.

This highly thrombotic syndrome results in macro-thrombosis and embolism. Strict thrombosis prophylaxis, close laboratory monitoring, and appropriate imaging monitoring, with early anticoagulant therapy in suspected venous thromboembolism are thus called for.

[Reference: https://www.rsna.org/news/2020/April/COVID-19-Blood-Clots]

A single-center study published in JAMA Cardiology showed that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) had no effect on the severity or outcome of patients with hypertension hospitalized for COVID-19

Juyi Li, MD, Tongji Medical College, Wuhan, China, and colleagues analyzed data from 1,178 patients with COVID-19 hospitalized at the Central Hospital of Wuhan from January 15 to March 15, 2020. Of the patients, 362 (30.7%) had hypertension (median age, 66 years, 52.2% male), and of these, 115 (31.8%) were taking ACEI/ARBs. 

The in-hospital mortality for the overall population was 11.0%. The in-hospital mortality for patients with hypertension was 21.3%. 

The percentage of patients with hypertension taking ACEIs/ARBs was no different between those with severe and nonsevere infections (32.9% vs 30.7%; P = 0.65). Aldo, it did not differ between nonsurvivors and survivors (27.3% vs 33.0%; P = 0.34). There were similar findings when data were analyzed for patients taking ACEIs and those taking ARBs.

In this single-center case series involving 362 patients with hypertension hospitalized with COVID-19 infection, there was no difference in severity of the disease, complications, and risk of death in those who were taking ACEIs/ARBs compared with those not treated with these medications. [JAMA Cardiology]

Acta Pharmaceutica Sinica B showed that supplementation with dipyridamole was associated with markedly improved clinical outcomes in patients with COVID-19, particularly in patients with severe disease 

Xiaoyan Liu, MD, Zhongnan Hospital of Wuhan University, Wuhan, and colleagues conducted an open label study involving 31 patients with COVID-19 treated at Dawu County People’s Hospital (1st hospital, 12 patients and 10 controls) and Huangpi Chinese Medicine Hospital (2nd hospital, 2 patients and 7 controls),  from February 3, 2020 to March 8, 2020. 

D-dimer concentrations were increased in 50% of patients in the dipyridamole group and in 42% of patients in the control group. 

Patients in the dipyridamole group received 50 mg oral tablets 3 times daily (total 150 mg) for 14 consecutive days. All patients were administered ribavirin, glucocorticoids, and oxygen therapy, but none received antifungal treatment. 

Dipyridamole adjunctive therapy was found to be associated with considerably improved clinical cure and remission rates in both the non-severe and severely ill patients. For the 8 severely ill patients in the dipyridamole group, 7 (87.5%) patients achieved clinical cure and were discharged from the hospitals, and the remaining 1 patient was in clinical remission. For the 12 severely ill patients in the control group, 4 (33.3%) patients were discharged, 2 (16.7%) were in remission, and 2 (16.7%) died. [Acta Pharmaceutica Sinica B]

A study published in the American Journal of Roentgenology showed that unsuspected COVID-19 may be strongly suggested on the basis of lung findings on abdominopelvic CT

Bari Dane, MD, New York University Langone Medical Center, New York, New York, and colleagues identified reports from abdominal (with a pelvic component) CT examinations of patients subjected to imaging from March 16, 2020, through March 26, 2020, and for whom the terms “COVID” or “pneumonia/pneumonitis” AND “atypical” appeared in the report impression. 

Overall, 23 patients were identified with unanticipated lung base findings on abdominopelvic CT that were concerning for COVID-19. Of these patients, 17 had positive COVID-19 test results. The remaining 6 patients did not have available COVID-19 test results or additional clinical information.

For the 17 patients with positive COVID-19 test results, the most common lung base findings on abdominopelvic CT were ground-glass opacities (n = 13), most commonly multilobar (n = 9), peripheral (n = 8), or peribronchovascular (n = 8) in distribution. Other patients had consolidation (n = 4) or ground-glass nodules (n = 3). No patients had any pleural effusion.

[American Journal of Roentgenology]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA