Aortic thrombus in patients with severe COVID-19: review of three cases

Abstract

Coronavirus disease 2019 (COVID-19) could predispose to both venous and arterial thromboembolism, in an exaggerated immune response to the virus, especially in severe patients. Even though aortic clots are a rare entity, the pro-coagulant nature of COVID-19 is associated with thrombosis in atypical locations and should be considered in patients with severe abnormalities in coagulation parameters. We describe a series of three cases of aortic thrombi diagnosed by computerized tomography (CT) angiography in patients with confirmed SARS-CoV-2 infection. Keywords COVID-19 • Aortic thrombi • Severe pneumonia Highlights• Floating aortic thrombus is an uncommon manifestation in severe SARS-CoV-2 infection. • The incidence of aortic thrombus among arterial thrombus could probably be underestimated. • CT angiogram may be of interest to diagnose aortic events in COVID-19 patients with no clinical improvement and high D-dimer values.

Acute Limb Ischemia in a Peruvian Cohort Infected by COVID-19

“…Several studies have sought the risk factors associated with the development of arterial thrombosis related to COVID-19, mainly hypertension, diabetes, dyslipidemia, heart failure, history of heart attack, and smoking, 6 , 12 , 13 finding a significant association between older age and coronary disease with ALI ( p < 0.001 ). 14 In our findings, 18 patients (60%) presented only one or no risk factors, presuming that the mechanism of action of arterial thrombosis would not be directly associated with the aforementioned risk factors.…”

Stroke in patients with COVID-19: Clinical and neuroimaging characteristics

“…The role of hypercoagulable state is strongly suggested by report of patients with high D-dimer values, CTA confirmed occlusion of anterior cerebral artery (ACA) or MCA and co-occurrence of floating thrombi in the ascending aorta [ 29 ], common carotid artery and/or internal carotid artery [ 10 , 30 ]. Cavallieri et al discussed the case of a young man with increased D-dimer and fibrinogen, elevated LDH and mild thrombocytosis who developed bilateral cerebellar ischemic lesions due to CTA confirmed occlusion of the left vertebral artery, posterior inferior cerebellar artery (PICA) and bilateral anterior inferior cerebellar artery (AICA) [ 31 ].…”

Severe thrombosis of abdominal aorta with distal embolism as the only clinical manifestation of Covid-19 infection

“…In that study only three patients developed acute lower limb ischemia and all of them had severe COVID-19 with bilateral pneumonia (3). Most of the COVID-19 patients who later presented with thromboembolic complications had an onset of severe respiratory symptoms before acute ischemia and thrombosis could be explained by accompanied hypoxia as an emerging cofactor in the thrombosis stimulation (3,4,6,7,9). Among the COVID-19 patients with acute leg ischemia, there were mostly thromboembolic events of the femoral or popliteal artery with frequent history of cardiovascular risk factors (3,4).…”

“…Most of the COVID-19 patients who later presented with thromboembolic complications had an onset of severe respiratory symptoms before acute ischemia and thrombosis could be explained by accompanied hypoxia as an emerging cofactor in the thrombosis stimulation (3,4,6,7,9). Among the COVID-19 patients with acute leg ischemia, there were mostly thromboembolic events of the femoral or popliteal artery with frequent history of cardiovascular risk factors (3,4). Cases like ours, with large arterial thrombosis that nearly occluded aorta with massive peripheral embolic occlusion on both legs, were rare, especially in patients without previous cardiovascular disease or risk factors (10,11).…”

“…Recent literature has shown that SARS-CoV-2 causes endothelial dysfunction leading to thrombosis mostly venous (2). Arterial thrombosis occurs rarely, usually in severe CO-VID-19 patients (2)(3)(4)(5)(6).…”