Abstract
Both arterial and venous thromboembolic events are common in patients hospitalized in intensive care units with severe COVID-19. These patients often have laboratory findings consistent with a hypercoagulable state, suggesting widespread thrombosis and fibrinolysis, as well as elevated levels of D-dimer, von Willebrand factor (VWF), and factor VIII. There is increasing evidence that these thromboembolic events are associated with worse outcomes. We present the case of a 61-year-old man admitted for bilateral pneumonia due to COVID-19 infection, who developed during his hospitalization; Bilateral pulmonary thromboembolism, an acute myocardial infarction due to multiple coronary thrombosis, an intracavitary thrombus and thrombus in the ascending aorta. The patient was treated with systemic fibrinolysis and full doses of anticoagulation for pulmonary embolism, an emergency primary percutaneous coronary intervention (PCI) was performed with the implant of a drug eluting stent (DES) in the left anterior descending artery (LAD). Triple therapy with aspirin, clopidogrel and heparin was maintained until discharge. After the patient discharge, aspirin was stopped and treatment with clopidogrel and dabigatran was maintained for three months. In a subsequent outpatient control, the thrombi of the left ventricle and the ascending aorta resolved.
Highlights
The SARS COV 2 virus infection is responsible for more than 4 million deaths worldwide since the outbreak of late 2019 [1]
We present the case of a 61-year-old man admitted for bilateral pneumonia due to COVID-19 infection, who developed during his hospitalization; Bilateral pulmonary thromboembolism, an acute myocardial infarction due to multiple coronary thrombosis, an intracavitary thrombus and thrombus in the ascending aorta
The patient was treated with systemic fibrinolysis and full doses of anticoagulation for pulmonary embolism, an emergency primary percutaneous coronary intervention (PCI) was performed with the implant of a drug eluting stent (DES) in the left anterior descending artery (LAD)
Summary
The SARS COV 2 virus infection is responsible for more than 4 million deaths worldwide since the outbreak of late 2019 [1]. Patients with severe COVID-19 often have laboratory findings consistent with a hypercoagulable state, suggesting widespread thrombosis and fibrinolysis, as well as elevated levels of D-dimer, von Willebrand factor (VWF), and factor VIII2 These patients manifest a “cytokine storm” [5], characterized by elevated levels of inflammatory markers such as C-reactive protein and interleukin-6, which have been linked to severity of pneumonia and mortality [6]. Even if the thrombotic phenomena are frequent, is rare that all these thromboembolic complications occur in the same patient at the same time as in the case of our patient We believe that this case is relevant as it highlights the close relationship between COVID-19 infection and the development of venous and arterial thromboembolic complications, its frequency, severity, the poor prognosis that it entails for patients and the current evidence on the treatment of these phenomena
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