Unusual arterial thrombotic events in Covid-19 patients

Roquetaillade, Charles de; Chousterman, Benjamin; Tomasoni, Daniela; Zeitouni, Michel; Houdart, Emmanuel; Guédon, Alexis; Reiner, Peggy; Bordier, Raphaëlle; Gayat, Étienne; Montalescot, Gilles; Metra, Marco; Mebazaa, Alexandre

doi:10.1016/j.ijcard.2020.08.103

Cited by 78 publications

(88 citation statements)

References 7 publications

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“…A recent review focusing on post-mortem examinations in COVID-19 patients reported pulmonary embolism as a major cause of death among COVID-19 patients, with a high prevalence of peripheral deep venous thrombo-embolism 12 . These observations are in line with several studies reporting a high proportion of both venous and arterial thrombotic events in severe COVID-19 patients [13][14][15] . Consequently, one can hypothesize that the high incidence of COVID-19 related MODS we observed might rely on diffuse thromboembolic complications.…”

Section: Discussionsupporting

confidence: 92%

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Timing and Causes of Death in Severe COVID-19 Patients

Roquetaillade

Bredin

Lascarrou

et al. 2021

Preprint

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Introduction: Although early identified as a deadly infectious disease, the precise mortality rate of the most severe forms of COVID-19 is a matter of debate. To the best of our knowledge, no study investigated so far, the causes that ultimately led to death as well as the relation between timing and causes of death.Material & Methods: We performed a retrospective study in eight ICU within eight French hospitals. All consecutive adult patients (aged≥ 18 years old) admitted in the ICU with a PCR-confirmed SARS-CoV-2 infection and acute respiratory failure were included in the analysis. Causes and timing of death were reported based on medical records. A binomial logistic regression statistical analysis was performed to identify the determinants associated with ICU-mortality.Results: From March 1st, 2020 to April 28th, 287 patients were admitted to ICU for SARS-CoV-2 related acute respiratory failure. COVID-19 related multiple organ dysfunction syndromes (MODS) was the leading cause of death (29%, n=27/93). End-of-life decisions occurred in 25% of patients (n=23/93). Secondary infections-related MODS accounted for 21% of ICU death, with a majority of ventilator-associated pneumonia. Fatal ischemic events (venous or arterial) occurred in 12% of patients. Refractory hypoxemia was a relatively uncommon cause of death and occurred only in 8 cases (9%). Regarding the timing of death, only one death occurred during the first three days of ICU admission. Determinants associated with ICU-mortality in logistic regression were age >65, requirement for vasopressors, renal replacement therapy and extracorporeal membrane oxygenation.Conclusion: Our data suggest the existence of a specific pattern of outcome in severe COVID-19 patients compared to severe bacterial and viral pneumonia, consisting in a high proportion of delayed COVID-19 related MODS.

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Section: Discussionsupporting

confidence: 92%

“…2). 14 [7][8][9][10][11][12][13][14][15][16][17][18][19] 16 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] 25 [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] 16 12 [9][10][11][12]…”

Section: Risk Factors For Icu-deathunclassified

Timing and Causes of Death in Severe COVID-19 Patients

Roquetaillade

Bredin

Lascarrou

et al. 2021

Preprint

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“…Apart from the venous thrombotic and thromboembolic events, there are also reports of arterial thrombosis including stroke, myocardial infarction, acute limb ischemia, aortic thrombosis, and splenic infarcts. [57–60] Microvascular thrombosis also is present in COVID-19 disease. Autopsies done on patients who died from COVID-19 infection demonstrated microvascular thrombosis in the lungs.…”

Section: Discussionmentioning

confidence: 99%

Role of Combining Anticoagulant and Antiplatelet Agents in COVID-19 Treatment: A Rapid Review

Matli

Farah

Maalouf

et al. 2021

Preprint

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Although primarily affecting the respiratory system, COVID-19 causes multiple organ damage. One of its grave consequences is a prothrombotic state that manifests as thrombotic, microthrombotic, and thromboembolic events.Therefore, understanding the effect of antiplatelet and anticoagulation therapy in the context of COVID-19 treatment is important. The aim of this rapid review is to highlight the role of thrombosis in COVID-19 and provide new insights on the use of antithrombotic therapy in its management. A rapid systematic review was performed using preferred reporting items for systematic reviews. Papers published in English on antithrombotic agent use and COVID-19 complications were eligible. Results showed that the use of anticoagulants increased survival and reduced thromboembolic events in patients. However, despite the use of anticoagulants, patients still suffered thrombotic events likely due to heparin resistance. Data on antiplatelet use in combination with anticoagulants in the setting of COVID-19 is quite scarce. Current side effects of anticoagulation therapy emphasize the need to update treatment guidelines. In this rapid review, we address a possible modulatory role of antiplatelet and anticoagulant combination against COVID‐19 pathogenesis. This combination may be an effective form of adjuvant therapy against COVID‐19 infection. However, further studies are needed to elucidate potential risks and benefits associated with this combination.

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“…It was emphasized that at the time of the ischemic arterial events, all the affected patients were under anticoagulant treatment- 50% received thromboprophylaxis dose, and 50% received full-dose anticoagulation. The authors mentioned several publications that have described COVID-19 patients presenting with acute extremity pain, in the absence of significant respiratory symptoms, and concluded that also mild COVID-19 cases may present with significant prothrombotic complications ( de Roquetaillade et al, 2021 ).…”

Section: Literature Reviewmentioning

confidence: 99%

A case of rapidly progressive upper limb ischemic necrosis in a patient with COVID-19

Makhoul¹,

Shukha²,

Hanna³

et al. 2021

International Journal of Infectious Diseases

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Aim For more than one year the health systems all over the world are combating the global Corona virus disease 2019 (COVID-19) pandemic, cased by a novel Corona virus (N-COV) which was first described in Wuhan city, China, presenting as an atypical infection of the lower respiratory tract. Methods COVID-19 is characterized by multisystemic involvement, and mortality is attributed mainly to the respiratory system involvement, which may lead to severe acute respiratory distress syndrome and respiratory failure. Several COVID-19 associated complications are being increasingly reported, among which arterial and venous thromboembolic events, that may lead to amputation of affected limbs. So far, a large number of reports have described hypercoagulability crises leading to amputation of lower limbs, while the National Library of Medicine (Medline) search revealed no cases of urgent upper limb amputation in COVID-19 patients. Results We here describe for the first time in literature, a case of upper limb ischemia in a COVID-19 patient, with rapid progression to hand necrosis, requiring urgent through-arm amputation of the upper limb. Conclusions Our case emphasizes the need for anticoagulant therapy in COVID-19 patients, and keeping in mind to stay aware for the possible thromboembolic COVID-19 related sequelae.

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Unusual arterial thrombotic events in Covid-19 patients

Cited by 78 publications

References 7 publications

Timing and Causes of Death in Severe COVID-19 Patients

Timing and Causes of Death in Severe COVID-19 Patients

Role of Combining Anticoagulant and Antiplatelet Agents in COVID-19 Treatment: A Rapid Review

A case of rapidly progressive upper limb ischemic necrosis in a patient with COVID-19

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