Risk of peripheral arterial thrombosis in COVID-19

Mestres, Gaspar; Puigmacià, Roger; Blanco, Carla; Yugueros, Xavier; Esturrica, Montserrat; Riambau, Vincent

doi:10.1016/j.jvs.2020.04.477

Cited by 50 publications

(55 citation statements)

References 3 publications

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“…While an association between acute viral respiratory disease and subsequent cardiovascular events had been described for other diseases (e.g., influenza) [5,6], several centers reported a decline in hospital admissions for acute cardiovascular and cerebrovascular emergencies during the COVID pandemic [7][8][9][10][11][12][13][14][15][16][17][18][19]. Since acute cardiovascular and cerebrovascular diseases remain leading causes for morbidity and mortality, further investigation of this concerning trend is warranted to identify potential implications for both health-care professionals and regulators.…”

Section: Introductionmentioning

confidence: 98%

Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

et al. 2020

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Aims The first reports of declining hospital admissions for major cardiovascular emergencies during the COVID-19 pandemic attracted public attention. However, systematic evidence on this subject is sparse. We aimed to investigate the rate of emergent hospital admissions, subsequent invasive treatments and comorbidities during the COVID-19 pandemic in Germany. Methods and results This was a retrospective analysis of health insurance claims data from the second largest insurance fund in Germany, BARMER. Patients hospitalized for acute myocardial infarction, acute limb ischemia, aortic rupture, stroke or transient ischemic attack (TIA) between January 1, 2019, and May 31, 2020, were included. Admission rates per 100,000 insured, invasive treatments and comorbidities were compared from January-May 2019 (pre-COVID) to January-May 2020 (COVID). A total of 115,720 hospitalizations were included in the current analysis (51.3% females, mean age 72.9 years). Monthly admission rates declined from 78.6/100,000 insured (pre-COVID) to 70.6/100,000 (COVID). The lowest admission rate was observed in April 2020 (61.6/100,000). Administration rates for ST-segment elevation myocardial infarction (7.3-6.6), non-ST-segment elevation myocardial infarction (16.8-14.6), acute limb ischemia (5.1-4.6), stroke (35.0-32.5) and TIA (13.7-11.9) decreased from pre-COVID to COVID. Baseline comorbidities and the percentage of these patients treated with interventional or open-surgical procedures remained similar over time across all entities. In-hospital mortality in hospitalizations for stroke increased from pre-COVID to COVID (8.5-9.8%). Conclusions Admission rates for cardiovascular and cerebrovascular emergencies declined during the pandemic in Germany, while patients' comorbidities and treatment allocations remained unchanged. Further investigation is warranted to identify underlying reasons and potential implications on patients' outcomes. Moritz Seiffert and Fabian J. Brunner share the first authorship.

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Section: Introductionmentioning

confidence: 98%

Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

et al. 2020

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“… 8 , 15 Finally, limb arteries can be affected in elderly patients and in pathological situations: upper limb ischemia in a 71-year-old diabetic man 7 and lower limb ischemia complicated by distal cutaneous embolism in a 71-year-old aged patient with severe COVID-19. 12 We present a femoral artery thrombosis in a 24 year-old adult without medical history and a negative etiological assessment except nonsevere COVID-19.…”

Section: Discussionmentioning

confidence: 97%

“…Acute coronary syndrome and myocardial infarction have been reported in case of COVID-19 but seem to be infrequent. 5 , 9 , 12 Vulliamy et al. 13 detailed acute aortoiliac and mesenteric arterial thrombotic occlusions in a 60-year-old patient and a 75-year-old patient, respectively, while another case of acute aortic thrombosis was described in association with pulmonary embolism in a 71-year-old woman.…”

Section: Discussionmentioning

confidence: 99%

Femoral Arterial Thrombosis in a Young Adult after Nonsevere COVID-19

Veyre

Poulain-Veyre

Esparcieux

et al. 2020

Annals of Vascular Surgery

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Introduction Few cases of arterial thromboembolisms have been reported after novel coronavirus disease 2019 (COVID-19) in case of severe infection or in elderly patients. We report a case of femoral arterial thrombosis in a young patient after nonsevere infection. Case description A common femoral artery thrombosis extended in the first third of superficial and profunda femoral arteries associated with tibial posterior and popliteal artery thrombosis was diagnosed in a 24-year-old man complaining of right lower limb pain for one month. The evolution was good after anticoagulation and antiaggregant treatments and thrombectomy. Etiologic assessment was negative except for nonsevere COVID-19. Discussion COVID-19 accesses host cells via angiotensin-converting enzyme 2 protein, abundant in the lungs, which is also expressed by endothelial cells and is associated with important inflammatory syndrome and coagulopathy, leading to vascular lesions. Thrombosis prevalence is not fully established and seems to be higher in case of major inflammation and in the intensive care unit (ICU). Arterial thromboembolisms are described in many vascular territories, each time in elderly patients, or in case of severe infection. We described a femoral arterial thrombosis in a young patient with negative etiological assessment except nonsevere COVID-19. Treatment consists in anticoagulation and antiaggregant drugs and thrombectomy. Preventing venous thromboembolism treatment is recommended in case of severe infection or in the ICU, but there is no clear recommendation for arterial thromboembolism prevention. This case should lead us to be very careful of the arterial event risk even if the infection is nonsevere and the patient is young.

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“…In another study, venous thromboembolism (VTE) was determined in 69% of anticoagulated COVID-19 patients in the intensive care unit ( 47 ). Peripheral arterial thrombosis was also reported in critically ill COVID-19 subjects ( 48 ). Cases of myocardial infarction associated with increased thrombosis were also reported among patients with COVID-19 ( 49 ).…”

Section: Introductionmentioning

confidence: 89%

Inflammation and thrombosis in patients with COVID-19: a prothrombotic and inflammatory disease caused by SARS Coronavirus-2

Pamukçu¹

2020

Anatol J Cardiol

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Coronavirus disease 2019 (COVID-19) caused by “Severe Acute Respiratory Syndrome Coronavirus-2” (SARS-CoV-2) infection emerged in Wuhan, a city of China, and spread to the entire planet in early 2020. The virus enters the respiratory tract cells and other tissues via ACE2 receptors. Approximately 20% of infected subjects develop severe or critical disease. A cytokine storm leads to over inflammation and thrombotic events. The most common clinical presentation in COVID-19 is pneumonia, typically characterized by bilateral, peripheral, and patchy infiltrations in the lungs. However multi-systemic involvement including peripheral thromboembolic skin lesions, central nervous, gastrointestinal, circulatory, and urinary systems are reported. The disease has a higher mortality compared to other viral agents causing pneumonia and unfortunately, no approved specific therapy, nor vaccine has yet been discovered. Several clinical trials are ongoing with hydroxychloroquine, remdesivir, favipiravir, and low molecular weight heparins. This comprehensive review aimed to summarize coagulation abnormalities reported in COVID-19, discuss the thrombosis, and inflammation-driven background of the disease, emphasize the impact of thrombotic and inflammatory processes on the progression and prognosis of COVID-19, and to provide evidence-based therapeutic guidance, especially from antithrombotic and anti-inflammatory perspectives.

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Risk of peripheral arterial thrombosis in COVID-19

Cited by 50 publications

References 3 publications

Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

Femoral Arterial Thrombosis in a Young Adult after Nonsevere COVID-19

Inflammation and thrombosis in patients with COVID-19: a prothrombotic and inflammatory disease caused by SARS Coronavirus-2

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