Corona Virus Disease 2019 in situ arterial and venous thrombosis in critically ill patients: a case series

• Published in: European Heart Journal - Case Reports 2020-12, Vol.4 (6), p.1-7
• Main Authors: Castro-Verdes, Mireya, Gkouma, Antonia, Wort, John, Ridge, Carole, Mirsadraee, Saeed, Padley, Simon, Sheikh, Awais, Singh, Suveer
• Format: Article
• Language: English
• Subjects: Case Series
• ISSN: 2514-2119; 2514-2119
• DOI: 10.1093/ehjcr/ytaa470

Abstract Background Corona Virus Disease 2019 (COVID-19) pneumonitis associated with severe respiratory failure carries a high mortality. Coagulopathy has emerged as a significant contributor to thrombotic complications. Case summary We describe two cases of severe COVID-19 pneumonitis refractory to conventional mechanical ventilation and proning position, transferred to our specialist centre for cardiorespiratory failure. Cross-sectional imaging demonstrated concurrent venous and aortic thrombosis with end-organ ischaemic changes. One patient received thrombolysis with a partial response. This could not be offered to the other patient due to a recent haemorrhagic event. Both patients died of multi-organ failure in the hospital. Discussion Concurrent aortic and venous thromboses are rare. This finding in COVID-19 cases, who were both critically ill patients, likely reflects the strongly thrombogenic nature of this illness which ultimately contributed to poor outcomes. The absence of deep vein thrombosis or a potential systemic source of embolism suggests in situ thrombosis. Further, the management of anticoagulation and thrombolysis is challenging in patients where an attendant bleeding risk exists.