Elsevier

Journal of Critical Care

Volume 60, December 2020, Pages 106-110
Journal of Critical Care

Severe arterial thromboembolism in patients with Covid-19

https://doi.org/10.1016/j.jcrc.2020.08.002Get rights and content

Highlights

  • There is a higher risk of coagulopathy in critically ill Covid-19 patients

  • Coagulopathy in Covid-19 patients can increase the risk of arterial thromboembolism despite absence of overt DIC.

  • Further studies are needed to determine which parameters are useful in monitoring coagulopathy

  • More research is needed to determine adequate anti-thrombotic therapy in Covid-19 patients, even in absence of overt DIC.

Abstract

Introduction

The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has emerged early December 2019 and was recently confirmed by the World Health Organization (WHO) to be a public health emergency of international concern. Earlier reports have shown coagulopathy in patients with severe coronavirus disease 2019 (Covid-19).

Main symptoms and important clinical findings

We present four critically ill Covid-19 patients, who were admitted to our hospital. They were treated with supportive care, oral chloroquine, and standard 2500 or 5000 International Units (IU) of dalteparine subcutaneously once daily. Two patients died during the course of their stay as a consequence of severe large vessel arterial thromboembolism. The other two patients survived but symptoms of paralysis and aphasia persisted after cerebral ischemia due to large vessel arterial thromboembolism. Patients showed no signs of overt disseminated intravascular coagulation (DIC) in their laboratory analysis.

Conclusion

This case series suggest that even in absence of overt DIC, arterial thromboembolic complications occur in critically ill patients with Covid-19. Further studies are needed to determine which parameters are useful in monitoring coagulopathy and which dose of anti-thrombotic therapy in Covid-19 patients is adequate, even when overt DIC is not present.

Keywords

Thrombosis
COVID-19
Disseminated intravascular coagulation
Anti-coagulant therapy
Coagulopathy
Imaging

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