Case Report: Asymptomatic COVID-19 patient with a subtle hypercoagulable state and fluctuating D-dimer level

Abstract

Background: COVID-19 can infect an asymptomatic person silently without any overt symptoms despite diffuse blood clots throughout the body. Clot formation is induced by COVID-19 associated coagulopathy that can cause a high mortality rate. D-dimer, a fairly decisive marker for the coagulopathy event, is physiologically a marker of the fibrinolysis process. The increase of D-dimers in COVID-19 cases must be followed up because it relates to the initiation of a cytokine storm. Case presentation: We report an asymptomatic patient with sudden D-dimer elevation who received anticoagulant therapy. After three days of heparin administration, D-dimer results became normal and anticoagulant therapy was stopped. However, on the 12th day, the D-dimer level rebounded back and was followed by an increase of hs-C-reactive protein, erythrocyte sedimentation rate, IL-6, although SARS-CoV-2 PCR result became negative. A hyperglycaemic reaction and a sudden increase of HbA1C was observed in the patient. After three weeks D-dimer had returned to normal levels, and so did the other markers. The patient recovered fully and still no symptoms were obvious. Conclusion: COVID-19 patients without symptoms may be at risk of an asymptomatic coagulopathy process. The decreasing level of D-dimer erroneously cannot ensure that the coagulopathy process stops.

Effect of Asymptomatic and Symptomatic COVID-19 on Acute Ischemic Stroke Revascularization Outcomes

“…4–6,20–24 These alterations have mainly been observed and are more pronounced in symptomatic patients with moderate or severe disease, 25 but they have also been described in asymptomatic infections. 26–28 This would explain the excess of bleeding complications after revascularization treatment in patients with both S-COVID and AS-COVID.…”

“…[4][5][6][20][21][22][23][24] These alterations have mainly been observed and are more pronounced in symptomatic patients with moderate or severe disease, 25 but they have also been described in asymptomatic infections. [26][27][28] This would explain the excess of bleeding complications after revascularization treatment in patients with both S-COVID and AS-COVID. The same biologic changes that increase the risk of bleeding in patients with COVID-19 also result in a higher clot burden, microvascular thromboinflammation, and endothelitis with subsequent impaired posttreatment reperfusion, thereby increasing the risk of stroke recurrence.…”

Comparison of coagulation profile and thromboembolic events among patients undergoing spinal surgery before and after COVID-19 pandemic

“…Caesario et al reported a sudden elevation of D-dimer in an asymptomatic COVID-19 patient, which became normal with three days of heparin administration and rebounded back some days after anticoagulant therapy was stopped. They concluded that asymptomatic COVID-19 patients might also be at risk of a coagulopathy impairment [ 18 ]. Mahardhika et al also reported a high D-dimer level in an asymptomatic woman who was later confirmed to be positive for COVID-19 [ 19 ].…”

Alterations in Pre/Post Oxygenator Flows Due to Fibrin Deposition in the CardioHelp System—A Case Report

“…Clinical scenarios such as planned procedures and bleeding often necessitate holding anticoagulation in patients on ECMO support (4). Surveillance of oxygenators during ongoing ECMO therapy to predict clot formation to avoid critical situations such as circuit failure and thrombus embolization is thus pertinent (5,6). Although monitoring circuit pressures may serve as a guide to ongoing hemodynamic changes, they cannot be solely relied upon since they may be misleading as seen in this case scenario.…”