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.
Subject(s)
Blood Coagulation Disorders/complications , COVID-19/complications , Disseminated Intravascular Coagulation/complications , Thrombosis/complications , Aged, 80 and over , Blood Coagulation , Blood Coagulation Disorders/drug therapy , Chloroquine/therapeutic use , Critical Illness , Disseminated Intravascular Coagulation/drug therapy , Fatal Outcome , Female , Humans , Male , Middle Aged , Thromboembolism/complications , Tomography, X-Ray Computed , COVID-19 Drug TreatmentABSTRACT
Venous thromboembolism (VTE) seems to be an underdiagnosed complication in COVID-19 patients. We present three male patients, aged 67, 29 and 71 years, who were admitted to the hospital with COVID-19. They all showed deterioration in the course of their disease caused by VTE. In our hospital, VTE was diagnosed in 10% of COVID-19 patients admitted to the general ward (non-ICU patients) despite regular thromboprophylaxis. Deterioration in the course of COVID-19 has differential diagnoses such as progression of the infection itself, secondary bacterial pneumonia, left heart failure and in our experience not infrequently VTE. We therefore recommend to consider VTE in COVID-19 patients with a sudden clinical deterioration such as hypotension, tachycardia, unexplained hypoxaemia or insufficient clinical improvement and to perform CT-angiography if indicated. A high dose of thromboprophylaxis in COVID-19 patients may be considered because of increased coagulation activation.