Systemic arterial thrombosis and acute mesenteric ischemia in a patient with COVID-19

Azouz, E. Michel; Yang, Sisi; Monnier‐Cholley, Laurence; Arrivé, Lionel

doi:10.1007/s00134-020-06079-2

Cited by 78 publications

(70 citation statements)

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“…Helms et al only reported four (2.6%) cases in a cohort study of 150 COVID-19 ICU patients [7]. Arterial complications may result in major morbidity as highlighted in recent case reports [27,28]. It is unclear whether the same mechanisms are involved in venous as in arterial clots.…”

Section: Discussionmentioning

confidence: 99%

“…A higher proportion of patients with thrombotic complications died when compared with those without but this was not statistically significant (32 (39.5%) vs. 27 (25.5%), p = 0.059). Median (IQR) ICU length of stay was longer in patients who developed thrombotic complications 17 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) days vs. 12 (7-13) days, p = 0.003).…”

Section: Mortalitymentioning

confidence: 99%

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Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study

et al. 2020

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Background Optimal prophylactic and therapeutic management of thromboembolic disease in patients with COVID-19 remains a major challenge for clinicians. The aim of this study was to define the incidence of thrombotic and haemorrhagic complications in critically ill patients with COVID-19. In addition, we sought to characterise coagulation profiles using thromboelastography and explore possible biological differences between patients with and without thrombotic complications. Methods We conducted a multicentre retrospective observational study evaluating all the COVID-19 patients received in four intensive care units (ICUs) of four tertiary hospitals in the UK between March 15, 2020, and May 05, 2020. Clinical characteristics, laboratory data, thromboelastography profiles and clinical outcome data were evaluated between patients with and without thrombotic complications. Results A total of 187 patients were included. Their median (interquartile (IQR)) age was 57 (49–64) years and 124 (66.3%) patients were male. Eighty-one (43.3%) patients experienced one or more clinically relevant thrombotic complications, which were mainly pulmonary emboli (n = 42 (22.5%)). Arterial embolic complications were reported in 25 (13.3%) patients. ICU length of stay was longer in patients with thrombotic complications when compared with those without. Fifteen (8.0%) patients experienced haemorrhagic complications, of which nine (4.8%) were classified as major bleeding. Thromboelastography demonstrated a hypercoagulable profile in patients tested but lacked discriminatory value between those with and without thrombotic complications. Patients who experienced thrombotic complications had higher D-dimer, ferritin, troponin and white cell count levels at ICU admission compared with those that did not. Conclusion Critically ill patients with COVID-19 experience high rates of venous and arterial thrombotic complications. The rates of bleeding may be higher than previously reported and re-iterate the need for randomised trials to better understand the risk-benefit ratio of different anticoagulation strategies. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Section: Mortalitymentioning

confidence: 99%

Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study

et al. 2020

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“… 13 UK Case report 1 1 (100) 29 0 (0) CNS (basilar artery) CT head None DM, RTA, asthma 1 (100) Azouz et al. 14 France Case report 1 1 (100) 56 - CNS (right MCA), aorta, and GIT (SMA) CT scan None NR 0 (0) Baldacini et al. 15 France Case report 1 1 (100) 62 0 (0) CNS (left and right MCA, left ICA, BA, left PCA) CT angiography None Acute myelogenous leukemia 1 (100) De Brarry et al.…”

Section: Methodsmentioning

confidence: 99%

“…Although there is a substantial pool of evidence of venous thrombotic and thromboembolic events in COVID-19 patients, 5 , 6 , 7 , 8 , 11 , 12 , 13 , 14 there are a few scattered reports on intra-arterial thrombosis (AT) in these patients. We, therefore, conducted a rapid systematic review of current scientific literature to identify and consolidate data on the incidence of AT in COVID-19 patients, age and sex distribution of these patients, as well as the clinical presentation, anatomical distribution, and outcomes of AT.…”

Section: Introductionmentioning

confidence: 99%

Arterial Thrombosis in Coronavirus Disease 2019 Patients: A Rapid Systematic Review

Cheruiyot

Kipkorir

Ngure

et al. 2021

Annals of Vascular Surgery

149

153

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Background Emerging evidence suggests that severe form of coronavirus disease 2019 (COVID-19) is mediated, in part, by a hypercoagulable state characterized by micro- and macro-vascular thrombotic angiopathy. Although venous thrombotic events in COVID-19 patients have been well described, data on arterial thrombosis (AT) in these patients is still limited. We, therefore, conducted a rapid systematic review of current scientific literature to identify and consolidate evidence of AT in COVID-19 patients. Methods A systematic search of literature was conducted between November 1, 2019, and June 9, 2020, on PubMed and China National Knowledge Infrastructure to identify potentially eligible studies. Results A total of 27 studies (5 cohort, 5 case series, and 17 case reports) describing arterial thrombotic events in 90 COVID-19 patients were included. The pooled incidence of AT in severe/critically ill intensive care unit–admitted COVID-19 patients across the 5 cohort studies was 4.4% (95% confidence interval 2.8–6.4). Most of the patients were male, elderly, and had comorbidities. AT was symptomatic in >95% of these patients and involved multiple arteries in approximately 18% of patients. The anatomical distribution of arterial thrombotic events was wide, occurring in limb arteries (39%), cerebral arteries (24%), great vessels (aorta, common iliac, common carotid, and brachiocephalic trunk; 19%), coronary arteries (9%), and superior mesenteric artery (8%). The mortality rate in these patients is approximately 20%. Conclusions AT occurs in approximately 4% of critically ill COVID-19 patients. It often presents symptomatically and can affect multiple arteries. Further investigation of the underlying mechanism of AT in COVID-19 would be needed to clarify possible therapeutic targets.

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“…Embolism from aortic thrombi superior to the mesenteric vessels is another notable cause of COVID-19 associated AMI, where a free-floating thrombus of the aortic arch was associated with an occlusion of the superior mesenteric artery. 5 Norsa et al 6 described a 62 year old male with cardiovascular risk factors who was SARS-CoV-2 PCR negative on nasopharyngeal and bronchoalveolar lavage, who had thromboembolism found in the inferior vena cava and superior mesenteric vein, resulting in mesenteric ischaemia requiring small intestine resection. Histological examination showed severe endothelitiis with RNA in-situ-hybridisation assay confirming SARS-CoV-2 presence in the intestinal mucosa, suggestive that superior mesenteric venous thrombosis with AMI can also present in the subacute phase of COVID-19 illness.…”

mentioning

confidence: 99%

COVID-19-Associated Thromboembolic Events Causing Acute Mesenteric Ischaemia

Fan

2020

Academic Radiology

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Systemic arterial thrombosis and acute mesenteric ischemia in a patient with COVID-19

Cited by 78 publications

References 0 publications

Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study

Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: a multicentre observational study

Arterial Thrombosis in Coronavirus Disease 2019 Patients: A Rapid Systematic Review

COVID-19-Associated Thromboembolic Events Causing Acute Mesenteric Ischaemia

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