COVID-19 as the cause of thrombosis: recognising COVID-19 infection in apparently asymptomatic patients

Abstract

COVID-19 has serious thrombotic complications in critically ill patients; however, thrombus is not a typical presenting symptom. This case report describes a patient with no respiratory symptoms who presented to the emergency department with abdominal pain. The pain was attributed to renal thrombosis, but the patient was found to have no risk factors for thrombotic disease and subsequent hypercoagulable work-up was unremarkable. Pulmonary manifestations of COVID-19 infection were detected incidentally on the abdominal CT scan and confirmed via PCR test. The patient was isolated and went on to develop mild respiratory failure secondary to COVID-19 infection. This case suggests that unexplained thrombus in otherwise asymptomatic patients can be a direct result of COVID-19 infection, and serves as a call to action for emergency department clinicians to treat unexplained thrombotic events as evidence of COVID-19.

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

“…COVID-19 has two silent killer mechanisms: silent hypoxia and massive thromboembolism, where a considerable number of SARS-CoV-2 infected individuals can be asymptomatic. [1][2][3] Silent hypoxia can be detected using pulse oximetry. Post-mortem reports indicate that thromboembolism is a more complex process involving a complicated interaction of SARS-CoV-2 virus invasion with platelets, endothelial cells, leukocytes, inflammation, and immune response.…”

“… 1 Silent hypoxia and blood clots throughout the body are sometimes not followed by any symptoms. 2 , 3 COVID-19 associated coagulopathy leading to massive thrombosis is the cause of high mortality rates and adds complexity in treating the disease. 4 , 5 It has been shown to be present in up to 31% of critically ill intensive care unit (ICU) patients.…”

Fatal pulmonary thromboembolism in asymptomatic COVID-19

“…There have been a handful of papers written about pulmonary thrombus or thromboembolism in asymptomatic COVID-19 infection [ 21 – 25 ]. These papers mostly describe individuals who were initially asymptomatic but later became symptomatic.…”

Mild COVID-19 Illness as a Risk Factor for Venous Thromboembolism

“…Moreover, arterial events have also been reported in patients with mild COVID-19 disease [ 22 - 26 ], as well as apparently idiopathic VTE in patients that were diagnosed with COVID-19 through screening tests [ 27 ].…”