Embolismo pulmonar agudo en pacientes con neumonía por SARS-COV2. Serie de Casos. [Acute Pulmonary Embolism in patients with SARS-COV2 pneumonia. Cases report]

Abstract

El sindrome respiratorio agudo severo coronavirus 2 (SARS-COV-2) descrito en Wuhan, China a finales del 2019, ha causado mas de 9 millones de infecciones en el mundo, y mas de 480 mil muertes. En Panama se han reportado mas de 28 mil casos, y mas de 500 muertes por COVID-19. Se ha observado un alto riesgo de complicaciones tromboticas, probablemente como consecuencia del dano vascular asociado con la infeccion viral y la inflamacion severa, con la contribucion patogena de las plaquetas que interactuan con la pared vascular y los leucocitos. Describimos 3 casos de pacientes hospitalizados en un hospital general en la provincia de Panama, Republica de Panama. Dos hombres y una mujer, edad promedio 40.6 anos, estadia hospitalaria promedio de 35.3 dias; ingresados con diagnostico de neumonia por SARS-COV-2, niveles elevados de dimero D (> 5 ug/mL), riesgo bajo calculado para embolia pulmonar. Encontrando embolia pulmonar aguda en las ANGIO tomografia y en un caso acompanado de trombosis venosa profunda. Todos recibian dosis profilactica de heparina de bajo peso molecular. Se necesitan algoritmos para identificar a aquellos susceptibles de desarrollar complicaciones tromboticas y enfermedades graves, determinar el papel de los biomarcadores y sistemas de puntuacion para estratificar el riesgo. Abstract The severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) described in Wuhan, China in late 2019, has caused more than 9 million infections worldwide, and more than 480 thousand deaths. In Panama, more than 28 thousand cases have been reported, and more than 500 deaths from COVID-19. A high risk of thrombotic complications has been observed, probably as a consequence of vascular damage associated with viral infection and severe inflammation, with the pathogenic contribution of platelets that interact with the vascular wall and leukocytes. We describe 3 cases of patients hospitalized in a general hospital in the province of Panama, Republic of Panama. Two men and one woman, average age 40.6 years, average hospital stay of 35.3 days; admitted with a diagnosis of SARS-VOC-2 pneumonia, elevated levels of dimer D (> 5 ug / mL), calculated low risk for pulmonary embolism. Finding acute pulmonary embolism on ANGIO tomography and in one case accompanied by deep vein thrombosis. All received prophylactic doses of low molecular weight heparin. Algorithms are needed to identify those susceptible to developing thrombotic complications and serious diseases, determine the role of biomarkers and scoring systems to stratify risk.