EXTRA-PULMONARY THROMBOSIS IN PATIENTS WITH CORONAVIRUS-19 DISEASE; CASE SERIES AND REVIEW OF THE LITERATURE

Authors

  • Madiha Iqbal Aga Khan University Hospital
  • Sher Muhammad Sethi Aga Khan university Hospital
  • Sadaf Hanif

DOI:

https://doi.org/10.55519/JAMC-03-10382

Keywords:

COVID-19, thrombosis, venous and arterial thrombosis, intracardiac thrombus, therapeutic anticoagulation

Abstract

Background: Coronavirus disease 19 (COVID-19) is a viral disease caused by SARS-CoV-2. There is an increased incidence of a thromboembolic phenomenon in patients with COVID-19 infection. Pulmonary embolism is the most common thrombotic presentation in COVID-19 patients. Extra-pulmonary thrombosis is an unusual thrombotic complication of COVID-19 disease. Methods: This study was conducted at The Aga Khan University Hospital from June-July'2021. Patients clinical and laboratory findings, treatment, and outcomes were recorded. Results: We report three cases with the diagnosis of COVID-19 pneumonia associated with extra-pulmonary thrombosis from June to July 2021. The mean age of the patients were 66.3 and two of them (66.6%) were male. The diagnosis of COVID-19 was confirmed by real-time reverse transcriptase-polymerase chain reaction analysis in all the three patients. Extra-pulmonary thrombosis was identified in the celiac artery and splenic veins in case 1, left common iliac artery in case 2, and left ventricular apical thrombus in case 3. All the patients were treated with anticoagulation. In total, two patients were discharged home after total recovery, while the third patient died. Conclusion: The take-home message is that COVID-19 infection is a pro-thrombotic condition that can provoke arterial and venous thrombosis. Extra-pulmonary thrombosis is increasingly identified with COVID-19 infection. It is important to remember that the patient might have no potential risk factor for thromboses, as COVID-19 infection per se is a risk to induce thrombosis.

References

Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020;395(10224):565-74.

Rotzinger DC, Beigelman-Aubry C, von Garnier C, Qanadli SD. Pulmonary embolism in patients with COVID-19: Time to change the paradigm of computed tomography. Thromb Res 2020;190:58-9.

Sharma N, Shukla R, Kumar K, Arora S, Warrier R, Philip S. Portal Vein Thrombosis-a Rare Complication of SARS-CoV-2 Infection. SN Compr Clin Med 2021;3(6):1416-9.

Casey K, Iteen A, Nicolini R, Auten J. COVID-19 pneumonia with hemoptysis: Acute segmental pulmonary emboli associated with novel coronavirus infection. Am J Emerg Med 2020;38(7):1544.e1-3.

Abou-Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management. Thromb Res 2020;194:101-15.

Scudiero F, Silverio A, Di Maio M, Russo V, Citro R, Personeni D, et al. Pulmonary embolism in COVID-19 patients: prevalence, predictors and clinical outcome. Thromb Res 2021;198:34-9.

Klok FA, Kruip M, van der Meer NJM, Arbous MS, Gommers D, Kant KM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thromb Res 2020;191:148-50.

Klok FA, Kruip M, van der Meer NJM, Arbous MS, Gommers D, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020;191:145-7.

Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nat Med 2020;26(7):1017-32.

Mui LW, Lau JF, Lee HK. Thromboembolic complications of COVID-19. Emerg Radiol 2021;28(2):423-9.

Franco-Moreno A, Piniella-Ruiz E, Montoya-Adarraga J, Ballano-Franco C, Alvarez-Miguel F, Peinado-Martinez C, et al. Portal vein thrombosis in a patient with COVID-19. Thromb Res 2020;194:150-2.

Kashi M, Jacquin A, Dakhil B, Zaimi R, Mahe E, Tella E, et al. Severe arterial thrombosis associated with Covid-19 infection. Thromb Res 2020;192:75-7.

Merz LE, Sinnenberg L, Gerhard-Herman MD, Vaduganathan M. Extensive Arterial Thrombosis in Covid-19. Am J Cardiol 2020;134:148-9.

Imaeda S, Kabata H, Shiraishi Y, Kamata H, Tsuruta H, Yuasa S, et al. Left Ventricular Thrombus With COVID-19 Complication in a Patient With Dilated Cardiomyopathy. CJC open 2021;3(1):124-6.

Kaki A, Singh H, Cohen G, Schreiber T. A case report of a large intracardiac thrombus in a COVID-19 patient managed with percutaneous thrombectomy and right ventricular mechanical circulatory support. Eur Heart J Case Rep 2020;4(6):1-5.

Moores LK, Tritschler T, Brosnahan S, Carrier M, Collen JF, Doerschug K, et al. Prevention, Diagnosis, and Treatment of VTE in Patients With Coronavirus Disease 2019: CHEST Guideline and Expert Panel Report. Chest 2020;158(3):1143-63.

Bikdeli B, Talasaz AH, Rashidi F, Sharif-Kashani B, Farrokhpour M, Bakhshandeh H, et al. Intermediate versus standard-dose prophylactic anticoagulation and statin therapy versus placebo in critically-ill patients with COVID-19: Rationale and design of the INSPIRATION/INSPIRATION-S studies. Thromb Res 2020;196:382-94.

Downloads

Published

2022-06-21

How to Cite

Madiha Iqbal, Sher Muhammad Sethi, & Sadaf Hanif. (2022). EXTRA-PULMONARY THROMBOSIS IN PATIENTS WITH CORONAVIRUS-19 DISEASE; CASE SERIES AND REVIEW OF THE LITERATURE. Journal of Ayub Medical College Abbottabad, 34(3), 553–558. https://doi.org/10.55519/JAMC-03-10382

Issue

Vol. 34 No. 3 (2022): JOURNAL OF AYUB MEDCIAL COLLEGE ABBOTTABAD

Section

CASE SERIES

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.