Acute Arterial Thromboembolism in Patients with COVID-19 in the New York City Area

Abstract

Background Coronavirus disease 2019 (COVID-19) predisposes to arterial and venous thromboembolic complications. We describe the clinical presentation, management, and outcomes of acute arterial ischemia and concomitant infection at the epicenter of cases in the United States. Methods Patients with confirmed COVID-19 infection between March 1, 2020 and May 15, 2020 with an acute arterial thromboembolic event were reviewed. Data collected included demographics, anatomical location of the thromboembolism, treatments, and outcomes. Results Over the 11-week period, the Northwell Health System cared for 12,630 hospitalized patients with COVID-19. A total of 49 patients with arterial thromboembolism and confirmed COVID-19 were identified. The median age was 67 years (58–75) and 37 (76%) were men. The most common preexisting conditions were hypertension (53%) and diabetes (35%). The median D-dimer level was 2,673 ng/mL (723–7,139). The distribution of thromboembolic events included upper 7 (14%) and lower 35 (71%) extremity ischemia, bowel ischemia 2 (4%), and cerebral ischemia 5 (10%). Six patients (12%) had thrombus in multiple locations. Concomitant deep vein thrombosis was found in 8 patients (16%). Twenty-two (45%) patients presented with signs of acute arterial ischemia and were subsequently diagnosed with COVID-19. The remaining 27 (55%) developed ischemia during hospitalization. Revascularization was performed in 13 (27%) patients, primary amputation in 5 (10%), administration of systemic tissue‐ plasminogen activator in 3 (6%), and 28 (57%) were treated with systemic anticoagulation only. The rate of limb loss was 18%. Twenty-one patients (46%) died in the hospital. Twenty-five (51%) were successfully discharged, and 3 patients are still in the hospital. Conclusions While the mechanism of thromboembolic events in patients with COVID-19 remains unclear, the occurrence of such complication is associated with acute arterial ischemia which results in a high limb loss and mortality.

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

“…6,26 Recently published studies, mostly from Asia, Europe, and the United States, have usually described venous involvement above the arterial since the beginning of the pandemic. 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.…”

“…[3][4][5] Recent publications have described a sudden increase on cases of arterial thrombosis in patients with COVID-19, conditioning Acute Limb Ischemia (ALI) and constituting a surgical emergency. 6,7 Peru is one of the most affected countries in the region by the pandemic, with a cumulative incidence of 23.57 per 1000 habitants. 8 These arterial complications, which have not been reported so far in Latin America, have been observed in our country, identifying an increase in cases of ALI in patients with COVID-19.…”

Outcomes After Vascular Surgery Procedures in Patients with COVID-19 Infection: A National Multicenter Cohort Study (COVID-VAS)

“… 12 A study published in 2021 with 49 patients of the New York Metro area with acute arterial thromboembolism, reported 10% of primary amputation, 18% of limb loss and 46% of intrahospital mortality. 13 In our series, seventeen (22.7%) patients required some type of amputation during hospital stay. Several studies have reported associated coagulopathy disorders in COVID-19 patients.…”

“…Nevertheless, we agree that during the pandemic months, all vascular centres have treated more severe and complex cases of peripheral arterial disease and more serious gangrenes than the previous year. 13 , 29 , 30 …”

Extensive Arterial Thrombus Following Discharge after a Covid-19 Infection

“…Disease severity is associated with increased inflammation, but not all patients adhere to the same chronological progression or symptomatology, and some patients present with thromboembolism as their first symptom. 5 , 6 …”