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American Journal of Medical Case Reports. 2020, 8(12), 486-490
DOI: 10.12691/AJMCR-8-12-15
Case Report

Extensive Peripheral Arterial Thrombosis in a Patient with SARS-CoV-2 Infection

Yuvraj S. Chowdhury1, Cristina A Mitre2, Vittorio E. Rotella3, Karan Garg4, David K Lee5, Pooja Belligund5, Lu Chen2, Paul Madaj1, Haytham A Aboushi6, Mohammad R. Al-Ajam5 and Samy I. McFarlane6,

1Division of Cardiovascular Disease and Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, New York, United States-11203

2Division of Cardiovascular Disease, VA NY Harbor Healthcare System, Brooklyn Campus, New York -11209

3Division of Vascular Surgery, VA NY Harbor Healthcare System, Brooklyn Campus, New York- 11209

4Division of Vascular Surgery, VA NY Harbor Healthcare System, Manhattan VA Medical Center, New York- 10010

5Division of Pulmonology and Critical Care, VA NY Harbor Healthcare System, Brooklyn Campus, New York- 11209

6Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, New York, United States-11203

Pub. Date: September 15, 2020
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Cite this paper

Yuvraj S. Chowdhury, Cristina A Mitre, Vittorio E. Rotella, Karan Garg, David K Lee, Pooja Belligund, Lu Chen, Paul Madaj, Haytham A Aboushi, Mohammad R. Al-Ajam and Samy I. McFarlane. Extensive Peripheral Arterial Thrombosis in a Patient with SARS-CoV-2 Infection. American Journal of Medical Case Reports. 2020; 8(12):486-490. doi: 10.12691/AJMCR-8-12-15

Abstract

Thrombosis is one of the major underlying pathogenetic mechanisms leading to increased morbidity and mortality among COVID-19 patients. Thromboembolic events as well as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are the major causes of death in this continued pandemic. While elevated D-dimer level suggests worse thrombotic outcomes, levels at which benefits of anticoagulation outweigh the bleeding risk is yet to be determined. In this report, we present a case of a 72-year-old man with COVID-19 presented with confusion and subsequently developed acute hypoxic respiratory failure. On hospital day 7, patient developed extensive peripheral arterial thrombosis with acute rise of D-dimer from 800 to 14,899 ng/ml. He was treated with heparin drip and underwent urgent brachial, radial and ulnar embolectomy under general anesthesia. In this report, we also discuss the pathogenetic mechanisms and management of thromboembolism in COVID-19 patients, highlighting the role of early detection and aggressive therapeutic interventions that could be life and / or limb saving strategy.

Keywords

COVID-19, limb ischemia, arterial thrombosis, point-of-care ultrasound, D-dimer

Copyright

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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