COVID-19 Related Arterial Coagulopathy

Abstract

Coronavirus disease of 2019 (COVID-19) is a disease caused by the novel coronavirus SARS-CoV-2, which is characterized by a multitude of clinical abnormalities, including hypercoagulability. Although thrombosis is commonly observed in sepsis, the hypercoagulable state associated with COVID-19 is much more dramatic and may not be related to either the severity of the disease or the D-dimer levels. It may be due to a prothrombotic state induced by the disease itself. We report three cases of arterial thrombosis with a significant clot burden requiring urgent medical and surgical intervention. It is now a common practice to initiate anticoagulation for deep venous thrombosis (DVT) prophylaxis based on the D-dimer level in hospitalized patients with COVID-19. However, in our clinical experience, D-dimer levels did not correlate well with the clot burden or the risk for future thrombosis.

Thrombotic complications of COVID-19

“…There have been over a dozen case reports and case series of ALI described in the literature [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]. These patients often have multiple thromboses involving different vessels throughout their bodies [27,31,[33][34][35][36][37][38]40]. Many of these patients do not have existing peripheral arterial disease [27][28][29][30][31]34,36,37,40,41].…”

“…These patients often have multiple thromboses involving different vessels throughout their bodies [27,31,[33][34][35][36][37][38]40]. Many of these patients do not have existing peripheral arterial disease [27][28][29][30][31]34,36,37,40,41]. Acute limb ischemia can even occur among patients already receiving thromboprophylaxis [34,37,39,41].…”

Extensive Arterial Thrombus Following Discharge after a Covid-19 Infection

“… 6 There are reports of low–risk patients whose courses are complicated by arterial thrombosis. 10 , 11 …”

“…A case reported by Singh et al. 11 describes a 69-year-old female Covid-19 patient who presented with aortic thrombus and multiple emboli one week after discharge. These cases demonstrate a thrombotic milieu that likely continues after the regression of symptoms.…”

Thrombosis management and challenges in COVID-19 patients presenting with acute coronary syndromes

“…The inflammatory responses, hypoxia, and diffuse DIC in COVID-19 as described above, predispose patients to arterial and venous thrombotic diseases[ 36 37 ] [ Table 1 ]. The incidence of thrombotic diseases has been reported in several studies.…”