Coagulopathy in COVID-19 infection: a case of acute upper limb ischemia

Abstract

<jats:title>Abstract</jats:title> <jats:p>Coagulation abnormalities and thrombosis have been recently identified as sequelae of severe infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report a case of severe coagulopathy manifesting with right upper limb arterial and deep vein thrombosis in an 80-year-old male patient with severe COVID-19 associated pneumonia. He clinically deteriorated and received care in the intensive care unit where he was intubated. At that point, his coagulation laboratory tests were deranged, and he eventually developed dry gangrene in his right thumb and index finger, as well as a deep venous thromboembolism in his right axillary vein. Despite receiving treatment dose anticoagulation and undergoing arterial embolectomy, revascularization was unsuccessful. Amputation of the right arm at the level of the elbow was considered, but the patient died from respiratory failure.</jats:p>

Acute mesenteric thrombosis in two patients with COVID-19. Two cases report and literature review

“…Thrombotic events seem to play a central role in systemic involvement. Risk factors associated with thrombotic complications in SARS-CoV-2 infection include male gender, hypertension, cardiovascular disease, obesity, and prolonged immobilization [ 2 , 4 , 9 , 10 ].…”

“…Thromboprophylaxis with low-molecular-weight heparin is recommended for all hospitalized patients with COVID-19. The recommended dosages are 40 mg daily in patients with a creatinine clearance >30 mL/min, and 30 mg daily in patients with 15–30 mL/min; unfractionated heparin is recommended when the creatinine clearance is <15 mL/min [ 1 , 2 , 4 , 9 , 10 , 16 , 19 ]. Patients with COVID-19 who require intensive care are considered to be at highest risk of thrombotic complications and death, and for this reason they require higher doses of anticoagulants.…”

“…It is believed that there is an activation of alternate and lectin complement pathways (C5b-9 [membrane attack complex], C4d, and mannose-binding protein-associated serine protease 2 [MASP2]), which injures the endothelial cells [ 8 ]. Finally, SARS-CoV-2 infection is associated with increases in levels of not only angiotensin but also other prothrombotic proteins such as tissue factor, factor VIII, von Willebrand factor, and plasminogen activation inhibitor-1 [ 2 , [8] , [9] , [10] ].…”

“…Concerning intestinal damage, the prothrombotic effects of the virus rise the incidence of mesenteric ischemia from a mere 0.09–0.2% in the general population to 1.9–3.8% in patients with COVID-19 [ 11 , 12 ]. Furthermore, complement activation through the alternative and lectin pathways results in endothelial injury and arteriolar thrombosis [ [4] , [5] , [6] , 10 , 13 , 14 ]. Hence, it is believed than microvascular changes, rather than major embolic events, play a central role in intestinal damage.…”

Case Report: Acute lower limb ischemia in a recovered COVID-19 patient

“…Therefore, appropriate prevention strategies and therapeutic measures remain a challenge because the exact mechanism is not fully understood and high-quality studies are lacking 16 . Our case shows that acute lower ischemia can happen after patients have recovered from COVID-19.…”