COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up

Abstract

Patients with acute respiratory distress syndrome due to infection with the novel coronavirus SARS-COV2 are currently considered at high risk of developing thromboembolic complications in both venous and arterial vessels. The use of anticoagulants for preventive or curative purposes should be considered to reduce the risk of thromboembolic events. We report a case of a patient with severe COVID-19 acute respiratory distress syndrome who consecutively developed a right femoral deep vein thrombosis related to the femoral central line and acute ischemia of the left upper limb related to a radial arterial line. He was under a therapeutic dose of low molecular weight heparin twice a day three days before. The femoral vein was free of thrombosis while the central line was placed under a duplex ultrasound. Thromboembolic events can occur in patients with severe COVID-19 despite therapeutic anticoagulants. Close monitoring of vascular access with duplex ultrasound may be required.

Arterial thromboembolic complications in COVID‐19 in low‐risk patients despite prophylaxis

“…The mechanism for coagulopathy in patients with COVID-19 is currently unknown. 7 The thromboembolic events described in these cases occurred after the cytokine storm and during the third week of the disease, despite having no risk factors for thromboembolism and being on intermediate prophylaxis dose. The arterial clots removed at surgery in the patient described in case two were white and consistent with being platelet-rich.…”

Hypertension, Thrombosis, Kidney Failure, and Diabetes: Is COVID-19 an Endothelial Disease? A Comprehensive Evaluation of Clinical and Basic Evidence

“…Patients with COVID19 often show clotting disorders, with organ dysfunction and coagulopathy, resulting in higher mortality [15,165,166]. Critical data came from the analysis of coagulation tests including prothrombin time (PT), activated partial thromboplastin time (APTT), antithrombin activity (AT), fibrinogen, fibrin degradation product (FDP), and D-dimer, in samples collected on admission and during the hospital stay of COVID-19 patients [167].…”

Pulmonary embolism in patients with COVID-19 pneumonia

“…Indeed, it is not recommended to base PE diagnosis on pulmonary ventilation-perfusion imaging [7]. The cumulative incidence of VTE on the wards is reported to be lower than in the ICU (10% versus 48% at 14 days, respectively) [8] where investigation for PE is not always feasible due to critical illness and prone position [9].…”