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Background:Background: Thrombocytopenia is a common complication of COVID-19 (coronavirus disease 2019). The possible mechanisms include decreased platelet production, increased platelet destruction, and consumption. According to studies, thrombocytopenia indicates a poor prognosis and increased mortality in COVID-19 patients. Meanwhile, thrombocytopenia is often complicated in ECMO (extracorporeal membrane oxygenation) due to shearing force in the circuit and heparin-induced thrombocytopenia (HIT). COVID-19 patients who are managed on ECMO are at high risk of developing thrombocytopenia and life-threatening bleeding.Aims: Aims: Venous thromboembolism prevention is critical in managing COVID-19 patients. The balance between bleeding secondary to thrombocytopenia and thromboembolic prophylaxis is challenging. ECMO support also increases the risk of thrombocytopenia. Our retrospective observation study reports the incidences of thrombocytopenia and major bleeding events in twenty-three COVID-19 patients who were managed with ECMO. Methods:Methods: We retrospectively reviewed the data of twenty-three patients who were diagnosed with COVID-19 and managed on ECMO. Thrombocytopenia is defined by platelet level lower than 150,000/uL. Incidences of thrombocytopenia and related complications were recorded and analyzed. Results:Results: Twenty-three adult patients who were diagnosed with COVID-19 received ECMO support. The mean age of patients was 45-year-old and mean body mass index (BMI) was 31.29. Seventeen patients were males, and eleven patients had at least one of the following pre-ECMO comorbidity: ten (43.5%) patients had hypertension, eleven (47.8%) patients had type 2 diabetes and four (17.3%) patients had hyperlipidemia. None of the patients were active smokers or had chronic lung disease when admitted. Anticoagulation was initiated on the day of admission.Twenty-one (91.3%) patients developed thrombocytopenia and HIT was excluded. Eighteen (78.3%) patients had hemorrhage requiring transfusion, with the gastrointestinal tract being the most common site. Other bleeding sites included brain, chest, tracheostomy area and cannulation site. Thromboembolic prophylaxis was held for active bleeding or platelet count threshold of < 30,000/uL. The overall mortality rate was 70.0%.

Introduction: COVID-19 has a variable clinical presentation ranging from flu-like symptoms to respiratory failure. Most patients have a mild form of disease and often recover at home over a period of weeks. For some, the highest morbidity of COVID-19 may not be associated with the acute phase of the disease, but rather the longstanding post-viral pulmonary fibrosis. Case Description: A 49-year-old man with a past medical history of coronary artery disease, obstructive sleep apnea, hypertension, and type two diabetes mellitus presented to the emergency department with a four-day history of fever, nausea, and diarrhea. He denied cough or dyspnea. Chest radiograph revealed bibasilar ground glass opacifications. He was positive for severe acute respiratory syndrome coronavirus 2 by polymerase chain reaction testing. His oxygen saturation was 95% on room air and he was discharged home without treatment. Over the following days, he developed a dry cough and mild dyspnea, but he did not desaturate on room air. He was prescribed a short course of steroids by his outpatient pulmonologist. He gradually improved over the course of two weeks and he was never hospitalized. Computed tomography (CT) of the chest 10 weeks after diagnosis revealed bilateral patchy ground glass opacities in all lobes and interstitial components with architectural distortion in the lower lobes (Image 1). A pulmonary function test performed 12 weeks after diagnosis showed an FVC 83%, FEV1 85%, TLC 75%, RV 37%, and DCLO 88%. The patient continued to experience mild dyspnea with exertion 2 months after the resolution of the infection. Conclusion: Pulmonary fibrosis is not a post-viral phenomenon limited to severe cases of COVID-19 and can occur following mild presentations managed at home. Thus far, risk factors for the development of pulmonary fibrosis secondary to COVID-19 have been reported to be advanced age, disease severity, length of intensive care unit stay, smoking, and alcoholism. Our case report calls for a re-evaluation of these risk factors. While pharmaceutical treatments are typically only administered to hospitalized patients, there may be basis for treating mild cases with the intent of preventing post-viral pulmonary fibrosis. Further, outpatient clinicians may consider monitoring for changes in pulmonary architecture with pulmonary function tests or high-resolution CT scans in all recovered COVID-19 patients regardless of symptom severity.

values of 3.6%, 2.9%, and 2.6%, respectively. (See stars in Fig. 2). Conclusion: This analysis revealed a great diversity of combinations of post-LVAD AEs. The most common basket of concomitant events {Bleeding, Other SAE} was only 10% of the 8,603 total baskets (855 count). Unfortunately, Other SAE is very common in the INTERMACS database and not very informative to clinicians. The most common basket that did not include Other SAE, was {Bleeding, Infection} which comprised 5% of the total baskets.