Case Series
Anticoagulation failure in pulmonary thromboembolism in COVID-19 pneumonia despite prolonged anticoagulation: A case series

https://doi.org/10.1016/j.amsu.2022.104929Get rights and content
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Highlights

  • Seven patients with anticoagulation failure in Pulmonary Thromboembolism following COVID-19 pneumonia.

  • Prolonged treatment of pulmonary thromboembolism for 3 months with novel anticoagulant-Rivaroxaban.

  • Suggestion on individualized treatment protocol for risk stratification and preventing complications of COVID-19.

Abstract

Introduction

Moderate to severely ill patients diagnosed with Coronavirus disease 2019 (COVID-19) pneumonia develop a series of complications and less frequently, we might witness cases of Pulmonary Thromboembolism (PE)-refractory to the standard treatment with Low Molecular Weight Heparin (LMWH). The aim of this case series is to report the presentation and management of pulmonary thromboembolism secondary to COVID-19 pneumonia.

Method

We report a case series of seven cases aged 40–70 who were presented in Dhulikhel Hospital with COVID-19 symptoms in different stages. The case details were extracted from their medical reports of the hospital. The written informed ethical consents were obtained from all the cases and their voluntary participation was assured.

Outcome

The cases in the case series admitted with COVID-19 pneumonia, after diagnostic investigation (Chest x-ray, HRCT, CTPA) were suggestive of COVID-19 Pneumonia with ARDS and pulmonary thromboembolism. The cases received rivaroxaban, a newer anticoagulant-15 mg twice daily for 21 days and after discharge, they were asked to continue once daily doses for 9 weeks. Significant improvement was witnessed, with the presence of additional intervention including rehabilitative chest exercises.

Conclusion

Pulmonary thromboembolism secondary to COVID-19 pneumonia is a life-threatening condition. Rivaroxaban is seen to be very effective in the management of this condition when an anticoagulation failure occurs even after the therapeutic dose of low molecular weight heparin. Future studies may require more scientific investigations to prevent complications even in the early stages of COVID-19.

Keywords

Anticoagulant
Case series
COVID-19
Pneumonia
Pulmonary thromboembolism

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