Unprovoked Submassive Saddle Pulmonary Embolism in an Adult Male After Pfizer COVID-19 Vaccination
https://www.cureus.com/articles/107450-unprovoked-submassive-saddle-pulmonary-embolism-in-an-adult-male-after-pfizer-covid-19-vaccination#references
Abstract
Pulmonary emboli (PEs) occur when the pulmonary artery is blocked by foreign material. In one such instance, this foreign material can be a blood clot that may occur from patient risk factors inducing a prothrombotic state. The relationship between COVID-19 vaccines and a prothrombotic state is novel and changing as our understanding of the relationship between the two evolves. The patient in this case study presented with unrelenting and progressive dyspnea, tachycardia, and unilateral lower extremity swelling two days after receiving the second dose of the Pfizer COVID-19 vaccine. After diagnostic testing, the patient was found to have a submassive saddle pulmonary embolism with subsequent right heart strain. This patient was treated with appropriate anticoagulation therapies, including heparin and apixaban, as well as thrombectomy, and made a complete recovery. The possible relationship between COVID-19 vaccines and thrombotic events supports the need for increased awareness of a potential new risk factor behind the development of PE. It is our hope that this case report will help raise awareness of an association despite the lack of incident data at this time.
Conclusions
This case report highlights a case of an upper middle-aged male who was diagnosed with an unprovoked submassive saddle pulmonary embolism on CT angiogram and who was successfully treated with catheter-assisted mechanical thrombectomy and pharmacologic anticoagulation. Pulmonary emboli usually have common risk factors, such as obesity or recent immobilization, that physicians are trained to recognize to help aid in diagnosis. The possible relationship between COVID-19 vaccines and a prothrombotic state should be considered as a feasible new risk factor when patients present with possible pulmonary emboli but lack typical symptoms or risk factors.