A Case of COVID-19 Related Coagulopathy Complications and Heparin Resistance

Abstract

Mechanisms of COVID-19 coagulopathy have been speculated and are not definitively understood; the current speculation is that there is elaborate crosstalk between the inflammatory and hemostatic systems which contributes to the overall increased thrombotic risk in the setting of COVID-19 resulting in a hypercoagulable state. A few documented reports regarding cases of apparent heparin resistance in patients with COVID-19 with complications of thromboembolic events occurring in the setting of heparin anticoagulation have been described. This phenomenon of heparin resistance has been observed in patients with active, severe COVID-19 infection. However, we describe a unique case of a patient who had recovered from a recent, mild COVID-19 infection that did not require hospitalization and presented with acute limb ischemia and demonstrated heparin resistance. The patient was managed by specialists in vascular surgery, intensivists, cardiologists, hematology, and physical medicine and rehabilitation (PMR). We present the case of a patient who had successfully recovered from COVID-19 yet demonstrated post-COVID-19 complications related to coagulopathy and heparin resistance.

Coagulopathy in severe COVID-19 patients: causes, concerns and current treatment regimen

“…However, 28-day mortality of heparin users was lower compared to non-users in patients with SIC (sepsis induced coagulopathy) score ≥4 (40.0% vs. 64.2%, p = 0.029), or D-dimer >6-fold of upper limit of normal (32.8% vs. 52.4%, p = 0.017). Although the mechanism is unclear, increasing numbers of patients developing resistance to heparin treatment have also been reported [39].…”

A case of COVID‐19 with pernio‐like skin lesions and increased red blood cell distribution width

“…In a hypercoagulable situation, the crosstalk between the inflammatory and hemostatic systems may advance for thrombosis in COVID-19. 4 Heparin resistance was observed in patients with COVID-19 infectious disease of the serious case. 4 Elevated RDW is associated with an increased risk for mortality from heart disease, pulmonary disease, sepsis, influenza, and cancer.…”

“…4 Heparin resistance was observed in patients with COVID-19 infectious disease of the serious case. 4 Elevated RDW is associated with an increased risk for mortality from heart disease, pulmonary disease, sepsis, influenza, and cancer. 5 RDW related to the death rate in Cox proportional hazards models adjusted for age, D-dimer level, and common comorbidities such as diabetes and hypertension.…”

“…Mechanisms of COVID‐19 coagulopathy have been proposed. In a hypercoagulable situation, the crosstalk between the inflammatory and hemostatic systems may advance for thrombosis in COVID‐19 4 . Heparin resistance was observed in patients with COVID‐19 infectious disease of the serious case 4 …”

“… 4 Heparin resistance was observed in patients with COVID‐19 infectious disease of the serious case. 4 …”