Isquemia aguda por trombosis aórtica en COVID-19: A propósito de un caso

Objetivo: Presentar un caso de isquemia aguda por trombosis aórtica en paciente con infección por COVID-19 y exponer la importancia del diagnóstico y manejo oportuno. Introducción: El coronavirus (COVID-19) afecta principalmente al tracto respiratorio, pero presenta predisposición a fenómenos trombóticos y sus complicaciones, siendo una de las más graves la isquemia aguda por trombosis aórtica. Caso clínico: Paciente masculino de 68 años, que cursa con cuadro clínico de neumonía grave por COVID-19, presenta de forma concomitante episodio de trombosis aórtica aguda, resultando con isquemia aguda de extremidades inferiores. Se realizó trombectomía, post procedimiento y asociado a reperfusión, presentó paro cardiorrespiratorio con asistolia sostenida, falleciendo pese a maniobras de reanimación. Conclusión: Pese a las medidas de profilaxis con heparina de bajo peso molecular (HBPM), se deben sospechar y buscar las complicaciones tromboembólicas en pacientes que cursan con esta infección para dar un manejo oportuno y vigilar las complicaciones post quirúrgicas que pueden ser mortales.

Aim: To present a case of acute ischemia due to aortic thrombosis in a patient with COVID-19 infection and explain the importance of diagnosis and timely management. Introduction: The coronavirus (COVID-19) mainly affects the respiratory tract, but it has a predisposition to thrombotic phenomena and its complications, one of the most serious being acute ischemia due to aortic thrombosis. Clinical case: 68-year-old man, coronary heart disease with severe pneumonia due to COVID-19, presents aortic thrombosis, resulting in acute lower extremity ischemia. Thrombectomy was performed, post procedure and associated with reperfusion, presented cardiorespiratory arrest with sustained asystole, died despite resuscitation maneuvers. Conclusion: Despite prophylaxis measures with low molecular-weight heparins (LMWH), thromboembolic complications should be sought in patients with this infection to provide timely management and monitor post-surgical complications that can be fatal.

Case Analysis o f Clinical Pharmacists Participating in Warfarin Individualized Anticoagulation Therapy for a Patient with Lo- wer Extremity Venous Thrombosis Complicated with Pulmonary Arterial Thromboembolism / 中国药房

OBJECTIVE： To investigate the role of clinical pharmacists in the individual anticoagulation of warfarin for the patients with lower extremity venous thrombosis （LEVT） and pulmonary arterial thromboembolism （PATE）. METHODS： Clinical pharmacists participated in individual anticoagulation of warfarin for the patients with LEVT and PATE. It was suggested to detect the gene type of the patient. According to the results of gene test [cytochrome P450 （CYP）2C9*1*1 and vitamin K epoxide reductase complex subunit Ⅰ] and the dose recommended by FDA based on the patient’s gene， the initial dose of warfarin （3.125 mg，once a day） was determined according to the patient’s living habits， height and body mass. Then the maintenance dose of warfarin （the maintenance dose of warfarin was 2.5 mg and 3.125 mg， once a day， alternately taken every other day） was calculated according to the warfarin maintenance dose prediction formula established by Warfarin Pharmaeogenetics Consortium. Pharmaceutical monitoring was conducted， such as INR， prothrombin time and bleeding event monitering. RESULTS： Physicians adopted the suggestion of clinical pharmacists. The maintenance dose of warfarin was 2.5 mg and 3.125 mg， once a day， alternately taken every other day. It was suggested to give Flucloxacillin sodium injection which had less influence on warfarin. The patient recovered well and was discharged. CONCLUSIONS： Based on pharmacogenomics， clinical pharmacists participate in the formulation of individualized anticoagulant regimens for patients， which promote TNR ralue of patients， reduce the risk of early postoperative thromboembolism， and further ensure the safety of drug use in patients.

A Case of Pulmonary Hypertension Recurred by Graves' Disease / 고신대학교의과대학학술지

A few cases of severe pulmonary hypertension with right heart failure associated with Graves' disease were reported in the literature. However, cases of pulmonary hypertension with right heart failure recurred by Graves' disease is very rare. We describe the case of a 60-year old woman who had been treated pulmonary hypertension caused by right pulmonary artery thromboembolism seven years ago. Recently, her pulmonary hypertension with right heart failure was recurred by Graves' disease. The patient's symptoms of pulmonary hypertension was resolved after treatment of Graves' disease.

Thromboembolic Occlusion of Left Bracheal artery Protein-C and Protein-S Deficiency – A Case Report.

Protein-C and Protein-S deficiency states are responsible for 3-5% (Protein-C) and 2-3% (Protein-S) of patients with venous thrombosis. Some cases of arterial thrombosis have been reported. It occurs twice as often in female as in males. A 50 years old lady presented with acute severe pain in the left upper limb for 2 days. On investigation she was diagnosed as a case of bracheal artery thrombosis with Protein-C & Protein-S deficiency. Bracheal thromboembolectomy was done and discharge her with life long warfarin therapy. In one year follow up the patient had no untoward event and INR done every month and warfarin is adjusted.