Concomitant acute lower extremity arterial and deep vein thrombosis developing in a patient under anticoagulant therapy after COVID 19 infection.
Trombosis arterial aguda y trombosis venosa profunda concomitantes de extremidad inferior en un paciente bajo terapia anticoagulante después de infección por COVID 19.
Abstract
The hypercoagulable state continues after the Coronavirus 2019 (Covid 19) infection and prophylactic anticoagulants are recommended in this period. However, arterial and venous thromboembolic events can be observed during the convalescence period after the Covid 19. Here, we present the case of acute lower extremity arterial and venous thromboembolism developed in
the post-Covid 19 period in a 77-years-old patient, under therapeutic doses of anticoagulant therapy (enoxparin 1mg/kg of weight every 12 hours). The patient, who had no previous history of arterial or venous thrombosis, was taken to emergency surgery with the diagnosis of ALI (acute limb ischemia) due to acute arterial thrombosis. An arterial thrombectomy was performed with the help of a 4F Fogarty catheter inserted from the left femoral artery under local anesthesia. All distal pulses of the patient were palpable in the postoperative period. After the platelet count became >100,000 mm3, 100 mg of acetylsalicylic acid daily was added to the therapeutic dose of enoxaparin sodium treat-
ment. The patient was discharged, uneventfully, except for a minimal diameter increase secondary to deep venous thrombosis (DVT) on the fifth postoperative day, with a combination of enoxaparin and acetylsalicylic acid treatment. Endothelial injury, chronic immuno-thrombogenicity, and increased platelet aggregation in the post-Covid 19 recovery period can cause major thrombotic events, even weeks after the recovery. Anticoagulant therapy is recommended for thromboprophylaxis when the following statuses exist: ≥65 years, critical illness, cancer, prior VTE, thrombophilia, severe immobility, and elevated D-dimer. Combination treatment with long-term antiaggregant therapy may be prudent in thromboembolic events developed under anticoagulant therapy.
Downloads
References
Fan BE, Cheung C. Post COVID-19 arterial thromboembolism: a clear and present danger. Semin Thromb Hemost 2022;48(01):112-114.
Sanchez JB, Alcalde JDC, Isidro RR, Luna CZ, Cubas WS, Charres AC, Gutierrez JE, Ochoa JD, Arias PF. Acute limp ischemia in a Peruvian cohort infected by COVID-19. Ann Vasc Surg 2021;72:196-204.
Clerkin KJ, Fried JA, Raikhelkar J, Sayer G, Griffin JM, Masoumi A, Jain SS, Burkhoff D, Kumaraiah D, Rabbani L, Schwartz A, Uriel N. Coronavirus Disease 2019 (COVID-19) and cardiovascular disease. Circulation 2020;141:1648-1655.
Del Castillo-García S, Minguito-Carazo C, Echarte JC,Santamarta MR, Gonzalez TB, Seara ST, Gonzalez LM, Fernandez-Vazquez F. A case report of arterial and venous thromboembolism in a patient with severe COVID-19 pneumonia. Eur Heart J Case Rep 2020;4(6):1-6.
Borrelli MP, Buora A, Scrivere P, Sponza M, Frigatti P. Arterial thrombotic sequalae after Covid-19: mind the gap. Ann Vasc Surg 2021;000:1.e1-1.e8.
Bozzani A, Arici V, TavazziG, Mojoli F, Bruno R, Sterpetti AV, Ragni F. Acute thrombosis of lower limbs arteries in the acute phase and after recovery from COVID19. Ann Surg 2021;273:159–160.
Jiang L, Tang K, Levin M, Irfan O, Morris SK, Wilson K, Klein JD, Bhutta ZA. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis 2020;20(11):e276–288.
Zaid Y, Puhm F, Allaeys I, Naya A, Oudghiri M, Khalki L, Limani Y, Zaid N, Sadki K, El Haj RB, Mahir W, Belayachi L, Belefquih B, Benouda A, Cheikh A, Langlois MA, Cherrah Y, Flamand L, Guessous F, Boilard E. Platelets can associate with SARS-Cov-2 RNA and are hyperactivated in COVID-19. Circ Res 2020;127:1404-1418.
Moores LK, Tritschler T, Brosnahan S, Carrier M, Collen JF, Doerschug K, Holley AB, Jimenez D, LeGal G, Rali P, Wells P. Prevention, diagnosis and treatment of venous thromboembolism in patients with COVID-19: CHEST Guideline and Expert Panel Report. Chest 2020;158:1143-1163. doi:10.1016/j.chest.2020.05.559.
Spyropoulos AC, Levy JH, Ageno W, Connors JM, Hunt BJ, Iba T, Levi M, Samama CM, Thachil J, Giannis D, Douketis JD; Subcommittee on perioperative, critical care thrombosis, haemostasis of the scientific, standardization Committee of the International Society on Thrombosis and Haemostasis. Scientific and Standardization Committee communication: Clinical guidance on the diagnosis, prevention, and treatment of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost 2020;18(8):1859-1865. doi:10.1111/jth.14929.
