Acute progressive arterial thrombosis after coronary artery bypass graft in a COVID-19 patient

Abstract

The longer the SARS-CoV-2 pandemic takes, the greater the prothrombotic effects of the disease, which varies from venous thromboembolic events to limb arterial thrombosis and stroke. How we deal with the effects of the COVID-19 disease, is still unclear. In this study, researchers will report the clinical presentation, outcome and management of the patient with COVID-19 after coronary artery bypass graft (CABG) surgery, which led to rapid progression of arterial thrombosis. The COVID-19 positive patient underwent emergency CABG, due to developed coronary artery disease. Despite receiving high-dose preoperative Plavix and heparin and also postoperative aspirin, the patient developed progressive thrombosis in both lower extremities 4 days after surgery. It then spread to bilateral iliac arteries, aorta, abdominal and renal artery. Femoral endarterectomy was performed two times for atheromatous plaque removal which was unsuccessful and the patient died few days later due to multi-organ failure. COVID-19 is a risk factor for arterial thrombosis with high mortality and morbidity rate. If thrombosis happens, the prognosis will be poor. Comprehensive treatments have to be started immediately after diagnosis. In patients undergoing surgery for extensive arterial thrombosis due to poor prognosis, not only surgical revascularization is needed but also thrombolysis treatments may be considered as off-label use. As the pandemic continues, new approaches and interventions may be applied.

Bilateral upper extremity thrombosis associated with protein C deficiency in a COVID-19 patient; a case report

“…Based on the evidence, cardiovascular involvement during COVID-19 disease may play a major role in the prognosis. COVID-19 has been associated with increased cardiovascular complications including myocarditis, arrhythmias and pulmonary embolism (2,5).…”

“…Intra cardiac thrombosis has rarely been reported in COVID-19 patients (7,8). Right heart thrombus formations a critical condition which can lead to pulmonary embolism (2,9). In some studies, inherited thrombophilia has been reported to increase the risk of thrombosis in COVID-19 patients (10).…”

“…Coronavirus disease 2019 (COVID-19) disease can be a critical illness with multi-organ involvement. Thrombosis formation, in these patients can be associated with increased mortality and morbidity (1,2).…”

“…Pulmonary embolism (3), stroke, venous thrombosis (4) and ischemic heart disease have been reported as thrombotic complications (1,2). We present an interesting case of protein C deficiency which was diagnosed after COVID-19 infection and manifested with different vascular complications.…”