A Case of Covid-19 Patient with Acute Limb Ischemia and Heparin Resistance

Abstract

Heparin resistance is an uncommon phenomenon defined as the need for high-dose unfractionated heparin (UFH) of more than 35,000 IU/day to achieve the target activated partialthromboplastin time ratio or the failure to achieve the desired activated clotting time after a full UFH dose. This rare phenomenon is being more commonly observed in Covid-19 patients in a hypercoagulable state. We describe a Covid-19 patient confirmed by reversetranscriptase polymerase chain reaction assay, with acute limb ischemia, who developed heparin resistance. The patient was managed by the departments of vascular surgery, anesthesia and intensive care, and the

Acute limb ischemia in a COVID-19 patient

“…However, his condition was resistant to treatment, and tended to recur. This finding is in correlation with reports by others [ 2 , [6] , [7] , [8] ]. Bellosta and colleagues [ 6 ] described 20 patients (18 men) with COVID-19-associated ALI over a period of 3 months.…”

“…The other patient, a man aged 37 years with upper extremity thrombosis was successfully managed with UFH administration [ 7 ]. Baccellieri and colleagues [ 8 ] reported a patient who developed COVID-19-associated ALI while under prophylactic LMWH. The 67-year-old man with no relevant medical history was successfully treated with surgical intervention for simultaneous lower and upper limb ischemia [ 8 ].…”

Acute Limb Ischemia in a Peruvian Cohort Infected by COVID-19

“…7,31 Distributed between short and isolated records, more frequent arterial involvement was shown in the lower limbs, predominantly the popliteal, anterior and posterior tibial, superficial femoral, iliac, and distal aorta. 7,12,23,24,26,28,[32][33][34] This distribution coincides with our findings where these arteries were mainly counting about 50% of the total of vessels involved.…”

“…18,21,22 ALI in COVID-19 can occur in two situations. During the in-hospital evolution of severe COVID-19 infection 6,[23][24][25][26] , Zhan et al has reported a median of 19 (11-23 days) from the appearance of symptoms of the infection to the installation of ischemia 27 or they can be admitted to the emergency room for this vascular condition with mild or no respiratory symptoms. [28][29][30] We report an ischemic time of 39 hours, defined from the apparent onset of symptoms to surgical intervention.…”

“…The factors that determined this time were related to the absence of an early and timely diagnosis, fear of patients going to the hospital, care focused on other more urgent symptoms of COVID-19 infection, availability of beds for management in critical areas, emergency Conventional catheter embolectomy was the only revascularization treatment in our series (75.9%), as most reports in both upper and lower limbs. 6,23,24,28 Pharmacological thrombolysis was applied occasionally in some reports, associated with thrombectomy 6,17 or as the only procedure. 28 Other treatments described were angioplasties with or without a stent or bypass.…”