Acute splanchnic vein thrombosis in patients with COVID-19: A systematic review

Buso, Giacomo; Becchetti, Chiara; Berzigotti, Annalisa

doi:10.1016/j.dld.2021.05.021

Cited by 18 publications

(16 citation statements)

References 52 publications

(86 reference statements)

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“…Current recommendations for in-hospital patients with COVID-19 requiring anticoagulation suggest LMWH as first-line treatment has advantages, with higher stability compared to heparin during cytokine storms, and a reduced risk of interaction with antiviral therapy compared to oral anticoagulant medication [ 77 ]. Choosing the adequate doses of LMWH in specific cases—prophylactic, intermediate, or therapeutic—is still in debate.…”

Section: Discussionmentioning

confidence: 99%

Acute Mesenteric Ischemia in COVID-19 Patients

Serban

Tribus

Vancea

et al. 2021

JCM

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Acute mesenteric ischemia is a rare but extremely severe complication of SARS-CoV-2 infection. The present review aims to document the clinical, laboratory, and imaging findings, management, and outcomes of acute intestinal ischemia in COVID-19 patients. A comprehensive search was performed on PubMed and Web of Science with the terms “COVID-19” and “bowel ischemia” OR “intestinal ischemia” OR “mesenteric ischemia” OR “mesenteric thrombosis”. After duplication removal, a total of 36 articles were included, reporting data on a total of 89 patients, 63 being hospitalized at the moment of onset. Elevated D-dimers, leukocytosis, and C reactive protein (CRP) were present in most reported cases, and a contrast-enhanced CT exam confirms the vascular thromboembolism and offers important information about the bowel viability. There are distinct features of bowel ischemia in non-hospitalized vs. hospitalized COVID-19 patients, suggesting different pathological pathways. In ICU patients, the most frequently affected was the large bowel alone (56%) or in association with the small bowel (24%), with microvascular thrombosis. Surgery was necessary in 95.4% of cases. In the non-hospitalized group, the small bowel was involved in 80%, with splanchnic veins or arteries thromboembolism, and a favorable response to conservative anticoagulant therapy was reported in 38.4%. Mortality was 54.4% in the hospitalized group and 21.7% in the non-hospitalized group (p < 0.0001). Age over 60 years (p = 0.043) and the need for surgery (p = 0.019) were associated with the worst outcome. Understanding the mechanisms involved and risk factors may help adjust the thromboprophylaxis and fluid management in COVID-19 patients.

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Section: Discussionmentioning

confidence: 99%

Acute Mesenteric Ischemia in COVID-19 Patients

Serban

Tribus

Vancea

et al. 2021

JCM

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“…148 The increase in cases of portal vein thrombosis (PVT) is an alarming complication observed in COVID-19 cases, which may trigger intestinal infarction and ischemia. 149 Even with prophylactic measures in the ICU, the frequency of thrombotic complications in critically ill patients is around 30%. 150 The cytokine storm associated with patient immobilization and hypoxia is believed to be the cause of PVT and its primary diagnosis is performed via US and Doppler or CT due to initial complaints of abdominal pain.…”

Section: Hepatic Ultrasonography In Patients With Covid-19mentioning

confidence: 99%

“…The increase in cases of portal vein thrombosis (PVT) is an alarming complication observed in COVID‐19 cases, which may trigger intestinal infarction and ischemia 149 . Even with prophylactic measures in the ICU, the frequency of thrombotic complications in critically ill patients is around 30% 150 .…”

Section: Livermentioning

confidence: 99%

COVID‐19 pathophysiology and ultrasound imaging: A multiorgan review

Ito

Rodrigues

Hümmelgen

et al. 2022

J of Clinical Ultrasound

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COVID‐19 is a dynamic disease and may affect different tissues and organs as it progresses. Therefore, the impact generated by the disease in all its stages and organs requires a functional and versatile imaging technique able to detect particularities or artifacts dynamically. Ultrasonography fulfills all these requirements and exhibit several advantages relative to other imaging modalities, including portability, lower cost and biosafety. Throughout the COVID‐19 pandemic, ultrasonography displayed a crucial role in the triage, monitoring, indicating organ damages and enabling individualized therapeutical decisions in COVID‐19 patients. This review is dedicated to highlight the main pathological effects correlated with ultrasound changes caused by COVID‐19 in the lungs, heart and liver.

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“…Commonly intravenous Unfractionated heparin and subcutaneous enoxaparin are being used. Potential malabsorption in case of intestinal ischemia should always be considered a potential risk of lack of efficacy for oral therapy [17] . When anticoagulation in acute PVT is initiated early and continued for six months, recanalization can occur in more than 60% in the first week but in less than 20% if started after that [18] .…”

Section: Discussionmentioning

confidence: 99%