A review of aortic thrombosis in COVID-19 infection

Abstract

Aim: As the novel coronavirus disease 2019 (COVID-19) pandemic impacts the global healthcare system, evolving data show increased frequency of arterial and venous thromboembolism among patients with COVID-19 infection. Aortic thrombus is a rare thrombotic event with a wide spectrum of clinical manifestations and potential catastrophic complications. This study aimed to elucidate the clinical manifestations, diagnosis and treatment dilemmas of aortic thrombus with COVID-19 infection and raise awareness among frontline medical providers. Aortic thrombosis is rare, but if not considered early in the course of COVID-19 infection, the data suggest that the diagnosis will probably not be made until potentially serious complications arise. Methods: Literature review was conducted between November 1, 2019, and November 14, 2020, on PubMed and Embase to identify publications regarding aortic thrombosis among COVID-19 cases. Results: Most of the patients were male with a median age of 67 years, and had comorbidities (most commonly hypertension, dyslipidemia and diabetes mellitus). In our study, underlying atherosclerosis, a common risk factor for aortic thrombus, was identified among 56% of the patients. Aortic thrombus was symptomatic in 62% of these patients and most commonly manifested itself as acute limb ischemia (46%), whereas 30% of cases were found incidentally during the investigation of elevated inflammatory markers or increased oxygen requirement. Treatment was individualized given the lack of established guidelines for aortic thrombus, including anticoagulation, systemic and catheter directed thrombolysis, and surgical thrombectomy. Overall mortality was found to be 30% in our study. Conclusions: Although rare, aortic thrombus has high morbidity and mortality, and can present without any symptoms or underlying aortic disease. Aortic thrombosis is rare, but if not considered early in the course of COVID-19 infection, the data suggest that the diagnosis will probably not be made until potentially serious complications arise.

Aortic Thrombosis and Ischemic Stroke With Hemorrhagic Conversion in a Patient With Remote COVID-19 Infection: A Treatment Dilemma

“…Although we now have some data for the incidence of DVT and pulmonary embolism in patients with COVID-19 infection, the data for aortic thrombus is scarce. Due to the scarcity of the data, it is hard to predict the exact incidence of aortic thrombosis in patients infected with COVID-19 [ 7 ]. The current data on aortic thrombosis in patients with COVID-19 infection is limited to the case report and case series.…”

“…The current data on aortic thrombosis in patients with COVID-19 infection is limited to the case report and case series. In one literature review, 43 cases of COVID-19-related aortic thrombosis were identified, and most of the patients were male and above age 50 [ 7 ]. The common comorbidities were smoking, obesity, hypertension, and diabetes mellitus [ 7 - 8 ].…”

“…In one literature review, 43 cases of COVID-19-related aortic thrombosis were identified, and most of the patients were male and above age 50 [ 7 ]. The common comorbidities were smoking, obesity, hypertension, and diabetes mellitus [ 7 - 8 ].…”

“…The patient with aortic thrombosis can present with acute limb ischemia, CVA, chest pain, and abdominal pain [ 7 - 8 ]. A large number of patients were also found to have incidental aortic thrombosis [ 7 ].…”

“…The patient with aortic thrombosis can present with acute limb ischemia, CVA, chest pain, and abdominal pain [ 7 - 8 ]. A large number of patients were also found to have incidental aortic thrombosis [ 7 ]. So the diagnosis of aortic thrombosis should be considered in any patient of COVID-19 infection who presents with abdominal pain, chest pain, motor weakness, sensory loss, vision loss, facial drop, slurred speech, limb ischemia, or other signs of end-organ damage, particularly if they have elevated D-dimer as the higher D-dimer level is associated with increased mortality [ 7 ].…”