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1.
Crit Care Med ; 50(4): 624-632, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1769408

ABSTRACT

OBJECTIVES: Coronavirus disease 2019 has been reported to be a prothrombotic condition; however, multicenter data comparing this with other viral pneumonias in those requiring extracorporeal membrane oxygenation are lacking. We conducted a multicenter study using whole-body CT to examine the prevalence, severity, and nature of vascular complications in coronavirus disease 2019 in comparison with patients with other viral pneumonias. DESIGN: We analyzed whole-body CT scans for the presence of vascular thrombosis (defined as pulmonary artery thrombus, venous thrombus, systemic arterial thrombus, or end-organ infarct). The severity, distribution, and morphology of pulmonary artery thrombus were characterized. Competing risk cumulative incidence analysis was used to compare survival with discharge. SETTING: Three centers of the English national extracorporeal membrane oxygenation service. PATIENTS: Consecutive patients admitted with either coronavirus disease 2019 or noncoronavirus disease 2019 viral pneumonia admitted from January 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: One-hundred thirty-six patients (45.2 ± 10.6 yr old, 39/146 [27%] female) requiring extracorporeal membrane oxygenation support underwent whole-body CT scans at admission. Of these, 86 had coronavirus disease 2019 pneumonia, and 50 had noncoronavirus disease 2019 viral pneumonia. Vascular thrombosis was seen more often in patients with coronavirus disease 2019 (odds ratio, 12.9 [95% CI 4.5-36.8]). In those with coronavirus disease 2019, 57 (73%) demonstrated pulmonary artery thrombus or pulmonary perfusion defects. Eighty-two percent of thrombus exhibited emboli-like morphology. The location of pulmonary artery thrombus and parenchymal perfusion defects was only concordant in 30% of cases. The risk of mortality was higher in those with coronavirus disease 2019 compared with noncoronavirus disease 2019 pneumonia (χ2 = 3.94; p = 0.047). Mortality was no different in coronavirus disease 2019 patients with or without vascular thrombosis (χ2 = 0.44; p = 0.51). CONCLUSIONS: In patients who received extracorporeal membrane oxygenation, coronavirus disease 2019 is associated with a higher prevalence of vascular thrombosis compared with noncoronavirus disease viral pneumonias. The pattern of pulmonary vascular changes suggests concurrent embolic disease and small vessel disease. Despite this, vascular thrombosis was not linked to poorer short-term prognosis in those with coronavirus disease 2019.


Subject(s)
COVID-19/complications , Extracorporeal Membrane Oxygenation , Pneumonia, Viral/complications , Thrombosis/etiology , Adult , COVID-19/therapy , Female , Humans , Male , Middle Aged , Pneumonia, Viral/therapy , Prognosis , Thrombosis/diagnostic imaging , Tomography, X-Ray Computed
5.
Vasc Endovascular Surg ; 56(4): 454-458, 2022 May.
Article in English | MEDLINE | ID: covidwho-1613203

ABSTRACT

The COVID-19 pandemic has profoundly influenced the practice of medicine in Australia over the last 24 months. Recently, the development of several vaccines to COVID-19 has been accompanied by reports of an associated rare syndrome of thrombosis and thrombocytopaenia (VITTS). The possibility of this rare disorder confronts all clinicians who deal with acute thrombosis, particularly given the prevalence of patients who have recently been immunised. However, VITTS remains rare, and we believe unnecessary focus on its potential diagnosis may distract from other more common causes of acute thrombosis. We discuss this with reference to a recent case at our institution.


Subject(s)
COVID-19 , Thrombosis , COVID-19/complications , Humans , Pandemics , Thrombosis/diagnostic imaging , Thrombosis/etiology , Thrombosis/therapy , Treatment Outcome
8.
BMJ Case Rep ; 14(12)2021 Dec 07.
Article in English | MEDLINE | ID: covidwho-1562301

ABSTRACT

We present the case of an 82-year-old woman admitted to a regional emergency general surgery centre with severe left upper quadrant abdominal pain and tenderness within 21 days of receiving the first dose of the ChAdOx1 nCov-19 vaccine (Vaxzevria, AstraZeneca). Following further investigation through CT imaging, a thrombus was discovered in the patient's splenic artery resulting in a large splenic infarct. Splenic infarcts are rare and it is important to note the association between time of administration of the first dose of vaccine and the occurrence of thromboembolic complications in the noted absence of other risk factors for this condition. We hypothesise a link between Vaxzevria vaccine injection and a rare form of thromboembolic complication: thrombosis of the splenic artery.


Subject(s)
COVID-19 , Splenic Infarction , Thrombosis , Aged, 80 and over , COVID-19 Vaccines , Female , Humans , SARS-CoV-2 , Splenic Infarction/diagnostic imaging , Splenic Infarction/etiology , Thrombosis/diagnostic imaging , Thrombosis/etiology , Vaccination
9.
Ann Saudi Med ; 41(6): 392-395, 2021.
Article in English | MEDLINE | ID: covidwho-1556295

ABSTRACT

A high rate of thrombotic complications have been observed in patients infected with COVID-19. These complications are related to increased blood hypercoagulabity, which can cause both venous and arterial thrombosis. We report a case of a 60-year-old man with COVID-19 pneumonia and thrombotic occlusion of the infrarenal abdominal aorta at the time of admission to the hospital. A CT scan showed a crazy-paving pattern in the lungs, consistent with COVID-19. A clinical suspicion of aortic thrombosis was confirmed by CT angiography. Embolectomy was undertaken a few hours later. At the end of the procedure, the patient was taken to the intensive care unit while intubated. The patient then worsened, developing severe renal failure, and died on day 1 after admission to the hospital. A CT scan, which is necessary for diagnosis of COVID-19, and a CT angiography, can be used to diagnose thrombotic events. It should be kept in mind that arterial thrombosis can be present not only in hospitalized COVID-19 patients but also at the time of admission. SIMILAR CASES PUBLSHED: 1.


Subject(s)
COVID-19 , Thrombosis , Aorta, Abdominal/diagnostic imaging , Humans , Male , Middle Aged , SARS-CoV-2 , Thrombosis/diagnostic imaging , Thrombosis/etiology , Tomography, X-Ray Computed
16.
Ann Vasc Surg ; 79: 438.e1-438.e4, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1456980

ABSTRACT

BACKGROUND: Vaccine Induced Thrombotic Thrombocytopenia (VITT) is a rare complication following ChAdOx1 (AstraZeneca) vaccination. Venous thrombosis in unusual sites such as splachnic or intracranial thrombosis, is the commonest manifestation. CASE REPORT: We report a 35-year-old male patient who presented with acute left leg ischemia and thrombocytopenia 11-days after vaccination requiring emergent thrombectomy. During work-up, a localized thrombus was detected in the left carotid bifurcation mandating carotid thrombectomy. Localized right iliac thrombus causing a non-limiting flow stenosis was treated conservatively. The platelet aggregating capacity of patient's plasma was confirmed in a functional assay, thereby establishing VITT. CONCLUSION: To the best of our knowledge this is the first case presenting multiple arterial thromboses requiring surgical treatment after ChAdOx1 vaccination.


Subject(s)
Arterial Occlusive Diseases/surgery , Carotid Artery Thrombosis/surgery , Femoral Artery/surgery , Thrombectomy , Thrombosis/surgery , Vaccination/adverse effects , Adult , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/etiology , Carotid Artery Thrombosis/diagnostic imaging , Carotid Artery Thrombosis/etiology , Femoral Artery/diagnostic imaging , Humans , Iliac Artery/diagnostic imaging , Male , Thrombosis/diagnostic imaging , Thrombosis/etiology , Treatment Outcome
17.
J Cardiothorac Surg ; 16(1): 200, 2021 Jul 23.
Article in English | MEDLINE | ID: covidwho-1455985

ABSTRACT

BACKGROUND: The mural thrombus in the ascending aorta is rare, most of which are associated with aneurysm or atherosclerotic lesions, with high risks of causing catastrophic thrombotic events. A mural thrombus in the non-aneurysmal and non-atherosclerotic ascending aorta is exceptionally uncommon. CASE PRESENTATION: We reported a large mural thrombus in normal ascending aorta of an asymptomatic patient. Preoperative imaging confirmed the presence of the sessile thrombus located at the left anterior wall of ascending aorta. Given that it had the potential to cause fatal thrombotic complications, surgical removal and segment of ascending aorta replacement were executed. The patient had an uneventful recovery and discharged 14 days after surgery. CONCLUSIONS: Anticoagulant is the therapeutic cornerstone of ascending aortic thrombus, but surgery should be performed aggressively when the thrombus is large or floating to avoid severe embolic complications or recurrence.


Subject(s)
Aortic Diseases , Atherosclerosis , COVID-19 , Thrombosis , Aorta/surgery , Aortic Diseases/diagnostic imaging , Aortic Diseases/surgery , Atherosclerosis/complications , Atherosclerosis/diagnostic imaging , Humans , Male , Middle Aged , SARS-CoV-2 , Thrombosis/diagnostic imaging , Thrombosis/surgery , Treatment Outcome
18.
Radiologe ; 61(10): 909-914, 2021 Oct.
Article in German | MEDLINE | ID: covidwho-1437248

ABSTRACT

CLINICAL ISSUE: Clinically, COVID-19 (coronavirus disease 2019) is increasingly seen as a systemic disease associated with multiorgan involvement through a hypercoagulatory condition in the sense of vasculopathy. STANDARD TREATMENT: Treatment with antiplatelet drugs or heparins appears to be indicated. The current evidence, at least for acetylsalicylic acid (ASA), is lacking. DIAGNOSTIC WORK-UP: Corresponding to the significant proportion of primarily microstructural vascular changes, the radiological diagnosis showed not only macrovascular pathologies, but also diffuse perfusion disorders. PERFORMANCE: Regional hypoperfusion in the lungs can be detected with and without pulmonary arterial embolism. Similar findings can be found in almost all organ systems. PRACTICAL RECOMMENDATIONS: A therapeutic intervention using low molecular weight heparins in hospitalized patients in situation-adapted dosage is indicated and is discussed in detail. In the detection of micro- and macrovascular thrombosis in the context of COVID-19, extended radiological diagnostics play a central role and are the basis of adapted therapy and secondary prevention.


Subject(s)
COVID-19 , Pulmonary Embolism , Thrombosis , Humans , Platelet Aggregation Inhibitors/adverse effects , SARS-CoV-2 , Thrombosis/diagnostic imaging , Thrombosis/drug therapy
19.
Monaldi Arch Chest Dis ; 92(2)2021 Sep 16.
Article in English | MEDLINE | ID: covidwho-1412860

ABSTRACT

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 has varied manifestation with multisystem involvement. Acute coronary syndrome in COVID-19 as a result of stent thrombosis is an uncommon entity and is often due to hypercoagulable state. A 40-year-old male was referred to us with acute onset chest pain. He also reported fever, sore throat and dry cough for six days which mandated testing for COVID-19 which turned out to be positive. He had a prior history of coronary artery disease with a drug eluting stent implanted two years back. An electrocardiogram was suggestive of acute anterior wall myocardial infarction while echocardiogram revealed hypokinesia of left anterior descending (LAD) artery territory. Coronary angiogram revealed non-occlusive thrombus in proximal LAD stent. A Thrombolysis in Myocardial Infarction (TIMI) III flow was restored following balloon angioplasty with a non-compliant balloon and use of glycoprotein (GP) IIb-IIIa receptor antagonist. A diagnosis of very late stent thrombosis subsequent to COVID-19 was made.


Subject(s)
COVID-19 , Drug-Eluting Stents , Thrombosis , Adult , COVID-19/complications , COVID-19 Testing , Drug-Eluting Stents/adverse effects , Humans , Male , Platelet Aggregation Inhibitors , SARS-CoV-2 , Stents/adverse effects , Thrombosis/diagnostic imaging , Thrombosis/etiology
20.
Anatol J Cardiol ; 25(9): 600, 2021 09.
Article in English | MEDLINE | ID: covidwho-1399529
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