Coronavirus disease 2019 (COVID-19) has caused a global pandemic in just a few months, causing millions infected. Nearly 20% of COVID-19 patients present severe coagulation abnormalities, which may occur in almost all of the severe and critical ill COVID-19 cases. Concomitant venous thromboembolism (VTE), a potential cause of unexplained deaths, has been frequently reported in COVID-19 cases, but its management is still challenging due to the complexity between antithrombotic therapy and coagulation disorders. Based on frontline practical experience and comprehensive literature review, here a panel of experts and physicians from China and Europe developed an evidence and opinion-based consensus on the prophylaxis and management of VTE associated with COVID-19. This statement aims for clinicians treating COVID-19 and provides practical recommendations in detailed situations, for example, how to choose thromboprophylactic measures for patients with diverse severity of disease and bleeding risk, or which kind of anticoagulant should be prescribed. With limited experience on COVID19-associated VTE, this expert consensus statement should be helpful for clinicians worldwide with specific suggestions. From Pulmonary Embolism and Pulmonary Vascular Diseases Group of the Chinese Thoracic Society, Pulmonary Embolism and Pulmonary Vascular Disease Working Committee of Chinese Association of Chest Physicians, National Cooperation Group on Prevention and Treatment of Pulmonary Embolism and Pulmonary Vascular Disease, National Capacity Building Program Office for Prevention and Treatment of Pulmonary Embolism and Deep Vein Thrombosis, China Grade Center, Evidence-based Medicine Center of School of Basic Medical Sciences of Lanzhou University. Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang) and Department of Cardiovascular Surgery and Vascular Medicine of China-Japan Friendship Hospital (Peng Liu). Evidence-based Medicine Center of Lanzhou University (Yaolong Chen); China-Japan Friendship Hospital (Jun Wan, Wanmu Xie, and Zhenguo Zhai); Affiliated Hospital of Jianghan University (Chenghong Li); Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (Xiansheng Liu); the First Affiliated Hospital of Chongqing Medical University (Hong Chen); and the First Affiliated Hospital of Dalian Medical University (Yingqun Ji). General Hospital of Northern Theater Command (Zhuang Ma); Beijing Hospital (Xiaomao Xu); Huashan Hospital Affiliated to Fudan University (Shengqing Li); the Second Hospital of Hebei Medical University (Yadong Yuan); Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (Xiansheng Liu and Jianping Zhao); Affiliated Hospital of Jianghan University (Chenghong Li and Ziyang Zhu); the First Affiliated Hospital with Nanjing Medical University (Xuesong Chen); Renmin Hospital of Wuhan University (Ke Hu); Wuhan Asia Heart Hospital (Zhenlu Zhang), Wuhan Pulmonary Hospital (Ronghui Du); Wuhan Jinyintan Hospital (Ming Wei); the Central Hospital of Wuhan (Yi Hu); the First Affiliated Hospital of Zhengzhou University (Zhe Cheng); and China-Japan Friendship Hospital (Shuai Zhang). Peking University International Hospital (Shuang Liu); Peking Union Medical College Hospital (Juhong Shi); the First Affiliated Hospital of Chongqing Medical University (Hong Chen); the First Affiliated Hospital of Dalian Medical University (Yingqun Ji); the First Affiliated Hospital of Guangzhou Medical University (Chunli Liu); Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (Xiansheng Liu); the Second Hospital of Jilin University (Chunling Dong); the First Medical Center of Chinese PLA General Hospital (Weihua Zhang); Tangdu Hospital of Air Force Military Medical University (Ning Wang); Affiliated Hospital of Nantong University (Songshi Ni); the Affiliated Hospital of Qingdao University (Zhaozhong Cheng); Shandong Provincial Hospital (Ling Zhu); Ruijin Hospital Affiliated to Shanghai Jiao Tong University (Guochao Shi); Central Hospital Affiliated to Shenyang Medical College (Shuyue Xia); Shenzhen People's Hospital (Yingyun Fu); Beijing Chao-yang Hospital of Capital Medical University (Yuanhua Yang); West China Hospital of Sichuan University (Qun Yi); Shanghai Pulmonary Hospital Affiliated to Tongji University (Jinming Liu); the First Affiliated Hospital of Zhengzhou University (Jianjun Jin); Fuwai Hospital of CAMS and PUMC (Changming Xiong and Zhihong Liu); Xiangya Hospital of Central South University (Yongjun Tang); and China-Japan Friendship Hospital (Jun Wan, Wanmu Xie, Qian Gao, Yihong Sun, and Zhenguo Zhai). Beijing Hospital (Jing Wang); the First Affiliated Hospital of Chongqing Medical University (Yuliang Liu and Xiaohui Wang); Affiliated Hospital of Jianghan University (Qin Wei); Evidence-based Medicine Center of School of Basic Medical Sciences of Lanzhou University (Xuan Yu and Xufei Luo); Beijing Anzhen Hospital of Capital Medical University (Meng Zhang); and China-Japan Friendship Hospital (Kaiyuan Zhen and Zhu Zhang). General Hospital of Northern Theater Command (Lei Liu and Po Zhang); Peking University Third Hospital (Jing Zhang); Beijing Jishuitan Hospital (Yunjian Zhang); Beijing Hospital (Baomin Fang and Yongjun Li); the First Affiliated Hospital of Bengbu Medical College (Qixia Xu); Institute of Respiratory Diseases of Changsha Medical University (Aiguo Dai); the First Affiliated Hospital of Dalian Medical University (Zhonghe Zhang); the Second Affiliated Hospital of the Third Military Medical University (Ye Fan); Dongguan People's Hospital (Ruhong Xu); the First Affiliated Hospital of Fujian Medical University (Chaosheng Deng); Dongguan People's Hospital (Ping Zhang); State Key Laboratory of Respiratory Diseases of National Clinical Research Center for Respiratory Disease of Guangzhou Institute of Respiratory Health of the First Affiliated Hospital of Guangzhou Medical University (Cheng Hong, Jian Wang, and Nuofu Zhang); Guizhou Provincial People's Hospital (Weijia Liu); the First Affiliated Hospital of Henan University of Science and Technology (Yimin Mao); Key Laboratory of Respiratory Diseases of the Ministry of Health of the Department of Pathophysiology of Tongji Medical College of Huazhong University of Science and Technology (Qinghua Hu); Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (Guohua Zhen); the Second Hospital of Jilin University (Wei Xu); the Sixth Medical Center of PLA General Hospital (Yuying Li); Yan'an Hospital Affiliated to Kunming Medical University (Xiqian Xing); the First Affiliated Hospital with Nanjing Medical University (Weiping Xie); Inner Mongolia Baogang Hospital (Xiyuan Xu); Inner Mongolia People's Hospital (Jialie Wang); Shanxi Provincial People's Hospital (Aizhen Zhang); the First Hospital of Shanxi Medical University (Xiaoyun Hu and Yiwei Shi); Beijing Anzhen Hospital of Capital Medical University (Guangfa Zhu); Sichuan Provincial People's Hospital (Lu Guo); Tianjin Haihe Hospital (Qi Wu); Tianjin Medical University General Hospital (Jianlong Men and Lixia Dong); the First Affiliated Hospital of Wenzhou Medical University (Liangxing Wang); the First Affiliated Hospital of Xi'an Jiaotong University (Manxiang Li); Second People's Hospital of Tibet Autonomous Region (Wa Da); the People's Hospital of Xinjiang Uygur Autonomous Region (Ying Chen); Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region (Huiqin Yang); the First Affiliated Hospital of Xinjiang Medical University (Hui Liu); Tumor Hospital Affiliated to Xinjiang Medical University (Qin Luo); Sir Run Run Shaw Hospital Affiliated to School of Medicine of Zhejiang University (Ruifeng Zhang and Kejing Ying); the First Hospital of China Medical University (Fan Liu); and Fuwai Hospital of CAMS and PUMC (Zhihong Liu). The present consensus statement was based on its Chinese version which has been published previously in the National Medical Journal of China, 2020 March, 100(11):808–813. DOI: 10.3760/cma.j.cn112137-20200209-00227, with full permission from the journal office and the above academic groups. ^* Drs. Zhai, Li, Chen, and Elalamy contributed equally to the manuscript.

Objective: To evaluate pulmonary function and clinical symptoms in coronavirus disease 2019 (COVID-19) survivors within 3 months after hospital discharge, and to identify risk factors associated with impaired lung function.Methods and material: COVID-19 patients were prospectively followed-up with pulmonary function tests and clinical characteristics for 3 months following discharge from a hospital in Wuhan, China between January and February 2020.Results: 647 patients were included. 87 (13%) patients presented with weakness, 63 (10%) with palpitations and 56 (9%) with dyspnoea. The prevalence of each of the three symptoms were markedly higher in severe patients than nonsevere patients (19%versus10% for weakness, p=0.003; 14%versus7% for palpitations, p=0.007; 12%versus7% for dyspnoea, p=0.014). Results of multivariable regression showed increased odds of ongoing symptoms among severe patients (OR 1.7, 95% CI 1.1–2.6; p=0.026) or patients with longer hospital stays (OR 1.03, 95% CI 1.00–1.05; p=0.041). Pulmonary function test results were available for 81 patients, including 41 nonsevere and 40 severe patients. In this subgroup, 44 (54%) patients manifested abnormal diffusing capacity of the lung for carbon monoxide (D_LCO) (68% severeversus42% nonsevere patients, p=0.019). Chest computed tomography (CT) total severity score >10.5 (OR 10.4, 95% CI 2.5–44.1; p=0.001) on admission and acute respiratory distress syndrome (ARDS) (OR 4.6, 95% CI 1.4–15.5; p=0.014) were significantly associated with impairedD_LCO. Pulmonary interstitial damage may be associated with abnormalD_LCO.Conclusion: Pulmonary function, particularlyD_LCO, declined in COVID-19 survivors. This decrease was associated with total severity score of chest CT >10.5 and ARDS occurrence. Pulmonary interstitial damage might contribute to the impariedD_LCO.

Introduction Pulmonary embolism (PE) has not been accounted for as a cause of death contributing to cause-specific mortality in global reports. Methods We analyzed global PE-related mortality by focusing on the latest year available for each member state in the World Health Organization (WHO) mortality database, which provides age-sex–specific aggregated mortality data transmitted by national authorities for each underlying cause of death. PE-related deaths were defined by International Classification of Diseases, Tenth Revision codes for acute PE or nonfatal manifestations of venous thromboembolism (VTE). The 2001 WHO standard population served for standardization. Results We obtained data from 123 countries covering a total population of 2 602 561 422. Overall, 50 (40.6%) were European, 39 (31.7%) American, 13 (10.6%) Eastern Mediterranean, 13 (10.6%) Western Pacific, 3 (2.4%) Southeast Asian, and 2 (1.6%) African. Of 116 countries classifiable according to population income, 57 (49.1%) were high income, 42 (36.2%) upper-middle income, 14 (12.1%) lower-middle income, and 3 (2.6%) low income. A total of 18 726 382 deaths were recorded, of which 86 930 (0.46%) were attributed to PE. PE-related mortality rate increased with age in most countries. The reporting of PE-related deaths was heterogeneous, with an age-standardized mortality rate ranging from 0 to 24 deaths per 100 000 population-years. Income status only partially explained this heterogeneity. Conclusions Reporting of PE-related mortality in official national vital registration was characterized by extreme heterogeneity across countries. These findings mandate enhanced efforts toward systematic and uniform coverage of PE-related mortality and provides a case for full recognition of PE and VTE as a primary cause of death.

Serum uric acid (SUA) levels have been associated with an increased risk and recurrence of venous thromboembolism (VTE) in European populations, but the potential causal relationship remains unclear. Large-scale studies on the association between SUA and VTE in East Asian populations are lacking, despite the high prevalence of hyperuricemia in this region. To address this, we conducted a cohort analysis and a two-sample Mendelian randomization (MR) study in East Asian populations. We collected data on VTE patients from the China Pulmonary Thromboembolism Registry Study (CURES) and compared them to controls obtained from the China Health and Retirement Longitudinal Survey (CHARLS). Propensity score matching (PSM) and cubic-spline models were applied to assess the effect of SUA on VTE risk while adjusting for multiple covariates. We also performed two-sample MR analyses to infer potential causality based on summary statistics from Genome-wide Association Studies (GWAS) of SUA and VTE in the East Asian population. We found that the SUA levels were higher in VTE patients (317.95 mmol/L) compared to the general population (295.75 mmol/L), and SUA ≥ 325 mmol/L was associated with an increased risk of VTE recurrence (P-value = 0.0001). The univariable MR suggested a causal relationship between elevated SUA and higher VTE risk (P_{inverse variance weighted} < 0.05), and multivariable MR showed that elevated SUA levels continued to promote the development of VTE after adjusting for multiple covariates (P_{multivariable residual} < 0.05). Sensitivity analyses produced similar results for these estimations. Our study provides evidence supporting a robust positive association between SUA and VTE in the East Asian population, and MR analyses suggest that this association is likely to be causal. Our findings underscore the importance of monitoring SUA levels in VTE prevention and call for urgent action to address the growing burden of hyperuricemia in the Asia-Pacific region. This research was funded by 10.13039/501100005090 Beijing Nova Program (No. Z211100002121057), 10.13039/501100001809 National Natural Science Foundation of China (No. 82100065 and No. 62350004), CAMS Innovation Fund for Medical Sciences (No. 2021-I2M-1-061 and No. 2021-1-I2M-001), Elite Medical Professionals project of 10.13039/501100012173 China-Japan Friendship Hospital (No. ZRJY2021-QM12), National Key Research and Development Project (No. 2021YFF1201200 and No. 2022YFC3341004).

Similar trends of management and in-hospital mortality of acute pulmonary embolism (PE) have been reported in European and American populations. However, these tendencies are not clear in Asian countries. We retrospectively analysed the trends of risk stratification, management and in-hospital mortality for patients with acute PE through a multicentre registry in China (CURES).Adult patients with acute symptomatic PE were included between 2009 and 2015. Trends in disease diagnosis, treatment and death in hospital were fully analysed. Risk stratification was retrospectively classified by haemodynamic status and the simplified Pulmonary Embolism Severity Index (sPESI) score according to the 2014 European Society of Cardiology/European Respiratory Society guidelines.Among 7438 patients, the proportions with high (haemodynamic instability), intermediate (sPESI≥1) and low (sPESI=0) risk were 4.2%, 67.1% and 28.7%, respectively. Computed tomographic pulmonary angiography was the most widely used diagnostic approach (87.6%) and anticoagulation was the most frequently adopted initial therapy (83.7%). Between 2009 and 2015, a significant decline was observed for all-cause mortality (from 3.1% to 1.3%, adjusted p_{for trend}=0.0003), with a concomitant reduction in the use of initial systemic thrombolysis (from 14.8% to 5.0%, p_{for trend}<0.0001). The common predictors for all-cause mortality shared by haemodynamically stable and unstable patients were co-existing cancer, older age and impaired renal function.The considerable reduction of mortality over the years was accompanied by changes in initial treatment. These findings highlight the importance of risk stratification-guided management throughout the nation.