Arterial thrombotic complications in COVID-19 patients

Abstract

The coronavirus disease 2019 (COVID-19), a viral respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been described to predispose to thrombotic disease in both the venous and arterial circulations. We report four cases of an acute arterial occlusion in COVID-19 patients and literature review on the occurrence of arterial thrombosis in patients with COVID-19. Our findings demonstrate that physicians should be vigilant for signs of thrombotic complications in both hospitalized and new COVID-19 patients.

Case Report: Central Retinal Artery Occlusion in a COVID-19 Patient

“…The COVID-19 disease has been described to induce inflammatory-induced homeostasis changes that predispose to thrombotic disease in both venous and arterial circulation ( Levi et al, 2020 ; Levolger et al, 2020 ). Post-mortem analysis showed evidence of direct viral infection of the endothelial cells and diffuse endothelial inflammation leading to endothelial dysfunction and a procoagulant state ( Varga et al, 2020 ).…”

“…The risk of thromboembolic events in COVID-19 patients is currently under investigation, with preliminary results showing significantly prolonged prothrombin time, high D-dimer levels and increased concentrations of proinflammatory cytokines and biomarkers of inflammation in patients with more severe disease, indicating the likelihood of disseminated intravascular coagulation or thrombotic microangiopathy ( Connors and Levy, 2020 ; Levi et al, 2020 ). Even though most cases are affected by venous thromboembolism ( Llitjos et al, 2020 ), there are increasing reports of COVID-19 induced arterial thromboembolic complications, highlighting the thrombogenicity of SARS-CoV-2 infection ( Levolger et al, 2020 ). Lodigiani et al (2020) in a cohort of 388 consecutive patients with laboratory-proven COVID-19 requiring hospital admission, disclosed a remarkable rate of venous and arterial thromboembolic complications of approximately 8% despite the use of anticoagulant prophylaxis ( Lodigiani et al, 2020 ).…”

Acute arterial occlusion of the lower limb as the main clinical manifestation in a patient with Covid-19 – Case Report

“…He had a good outcome after surgery and was discharged 18 . In recent evidence, the involvement of arterial beds is usually associated with hospitalization for longer periods or patients in the ICU, being related to the clinical severity of the patient, with few studies that show symptoms of sudden pain in the lower limb without other complaints, as seen in our report 19 , 20 .…”

Case Report of Thrombosis of the Distal Aorta with Occlusion of Iliac Arteries in COVID-19 Infection

“…Here we present a case of a patient with thrombosis of the distal abdominal aorta and occlusion of bilateral iliac arteries complicated by severe rhabdomyolysis who presented with lower extremity pain and weakness in the University of California, San Diego, Department of Emergency Medicine, San Diego, California setting of a coronavirus disease 2019 (COVID-19) infection. Although cases of lower extremity arterial thrombosis have been described before, [1][2][3] our case is unique in that the patient was relatively young, presented without respiratory symptoms, and had bilateral leg involvement necessitating amputations. This case demonstrates the importance of maintaining a high index of suspicion for arterial thrombosis in patients with COVID-19 infection even in the absence of typical respiratory symptoms or other evidence of severe disease.…”

“…Coagulopathies have also been observed as complications associated with the virus. [1][2][3] These prothrombotic sequelae are not confined to the venous circulation. Here we present a case of a patient with thrombosis of the distal abdominal aorta and occlusion of bilateral iliac arteries complicated by severe rhabdomyolysis who presented with lower extremity pain and weakness in the University of California, San Diego, Department of Emergency Medicine, San Diego, California setting of a coronavirus disease 2019 (COVID-19) infection.…”