Acute Myocardial Infarction and Cardiac Thrombosis Due to Disseminated Intravascular Coagulation in Severe Covid19

Pandey, Shubhi; Satija, Vaibhav; Mishra, Ajay Kumar; Dai, Qiying; Filiberti, Allen

doi:10.1016/s0735-1097(21)03392-1

Cited by 2 publications

(4 citation statements)

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“…It has been shown that elevated D-dimer levels are associated with an increased risk of mortality [ 10 , 34 , 40 ]. DIC generally leads to systemic thrombosis; however, there are few cases in which coronary vessels are affected [ 14 - 18 ]. In the literature, there are few reports of COVID-19-associated DIC presenting as STEMI [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Antiplatelet and antithrombotic agents are contraindications in this context. Furthermore, it is uncertain whether invasive revascularization will be successful, given the high mortality rate reported in the literature [ 14 - 16 , 18 - 19 ]. In our case, the patient underwent an urgent cardiac catheterization that was unsuccessful.…”

Section: Discussionmentioning

confidence: 99%

“…DIC generally leads to systemic thrombosis; however, there are few cases in which coronary vessels are affected [14][15][16][17][18]. In the literature, there are few reports of COVID-19-associated DIC presenting as STEMI [18,19]. It is unclear how DIC contributes to coronary thrombosis.…”

Section: Isth Dic Criteria [P]: ≥5 Points Cac Criteria [O]: ≥2 Of The...mentioning

confidence: 99%

“…DIC results in systemic thrombosis but rarely involves the coronary vessels [11,[14][15][16][17]. A limited number of reports in the literature describe COVID-19-associated DIC presenting as ST-elevation myocardial infarction (STEMI) [18,19]. Herein, we present another instance of this association to emphasize the importance of maintaining a high index of suspicion and the challenges associated with managing patients in this situation.…”

Section: Introductionmentioning

confidence: 99%

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COVID-19-Associated Disseminated Intravascular Coagulopathy Presenting As Inferior ST-Segment Elevation Myocardial Infarction

Hakobyan¹,

Ilerhunmwuwa²,

Wasifuddin³

et al. 2023

Cureus

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Disseminated intravascular coagulopathy (DIC) is infrequently associated with COVID-19 infection. COVID-19 infection can predispose to thrombotic events through inflammation and microvascular injury. DIC is rarely associated with coronary artery disease, especially myocardial infarction (MI). In this case report, we present an uncommon case of a patient with concurrent DIC and MI in the setting of COVID-19 infection. A 73-year-old male patient with no known cardiovascular risk factor presented with syncope. Assessment in the field by emergency medical service (EMS) showed the patient had a third-degree atrioventricular block and a heart rate of 40 beats per minute. He was given atropine and transcutaneously paced. Upon admission, he was found to have an inferior wall ST-elevation myocardial infarction (STEMI) and tested positive for COVID-19. Cardiac catheterization was performed urgently and revealed triple vessel disease. Attempts to revascularize the vessels were unsuccessful. He subsequently developed cardiogenic shock. He was started on multiple pressor support. Laboratory workup was suggestive of DIC, and he later developed multiorgan failure. Continuous renal replacement therapy was initiated but failed due to persistent thrombosis of the dialysis access. Despite all measures, the patient developed cardiac arrest and passed away on the third day of hospitalization. Our understanding of COVID-19 and its complications has grown exponentially since the beginning of the pandemic. The pro-inflammatory state induced by the disease creates a hypercoagulable state that may result in thrombotic complications, including MI. In severe cases, a consumptive coagulopathy may develop, leading to DIC. This unique case report seeks to highlight the importance of staying vigilant about the potential complications of MI and DIC induced by COVID-19 so that prompt diagnosis can be made to reduce morbidity and mortality in these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Isth Dic Criteria [P]: ≥5 Points Cac Criteria [O]: ≥2 Of The...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

COVID-19-Associated Disseminated Intravascular Coagulopathy Presenting As Inferior ST-Segment Elevation Myocardial Infarction

Hakobyan¹,

Ilerhunmwuwa²,

Wasifuddin³

et al. 2023

Cureus

View full text Add to dashboard Cite

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Enoxaparin sodium

2021

Reactions Weekly

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Enoxaparin sodiumMultiple site bleeding: case report A 50-year-old woman developed multiple site bleeding during treatment with enoxaparin-sodium as an anticoagulant therapy. The woman presented with a COVID-19 pneumonia, and developed severe ARDS requiring ventilatory support. She received treatment with remdesivir and enoxaparin sodium [enoxaparin; route and dosage not stated] due to elevated D-dimer level. On hospital day 4, she became hypotensive, and the EKG showed a ST elevations in the inferior leads. Laboratory tests suggested disseminated intravascular coagulation. Coronary angiography showed a distal right coronary artery occlusion, which was relieved with drug-eluting stent placement. She was initiated on aspirin and ticagrelor. Post-percutaneous coronary intervention, EKG showed a persistent ST elevations, which was attributed to a possible ventricular aneurysm. Stent thrombosis was not considered because of falling troponin levels.The woman's treatment with enoxaparin sodium was discontinued because of bleeding from multiple sites [duration of treatment to reaction onset and outcome not stated]. After an hour, she developed refractory hypotension. Echocardiography revealed a severe right ventricular dysfunction and large thrombi in the right atrial and right ventricle. Subsequently, she died of cardiac arrest. A massive pulmonary embolism was considered for the likely cause of the death.

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Acute Myocardial Infarction and Cardiac Thrombosis Due to Disseminated Intravascular Coagulation in Severe Covid19

Cited by 2 publications

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COVID-19-Associated Disseminated Intravascular Coagulopathy Presenting As Inferior ST-Segment Elevation Myocardial Infarction

COVID-19-Associated Disseminated Intravascular Coagulopathy Presenting As Inferior ST-Segment Elevation Myocardial Infarction

Enoxaparin sodium

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