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Acute submassive pulmonary embolism after SARS-CoV-2 infection: a case report of reinfection or prolonged hypercoagulable state.
Pow, Timothy; Allen, Sorcha; Brailovsky, Yevgeniy; Darki, Amir.
  • Pow T; Department of Medicine, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, USA.
  • Allen S; Department of Cardiology, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, USA.
  • Brailovsky Y; Department of Cardiology, Columbia University Medical Center, 622 W 168th St, New York, NY 10032, USA.
  • Darki A; Department of Cardiology, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153, USA.
Eur Heart J Case Rep ; 5(3): ytab103, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1223357
ABSTRACT

BACKGROUND:

Coronavirus disease 19 (COVID-19) reinfection has been a topic of discussion with data still emerging. Viral antibodies are known to develop upon initial infection; however, it is unclear the amount of protection this confers against reinfection. Additionally, COVID-19-associated coagulopathy (CAC) is a well-documented phenomenon; however, there are no high-quality studies to support the treatment of outpatients beyond standard indications of venous thromboembolism (VTE) prophylaxis. This case describes a patient with either COVID-19 reinfection or prolonged course of CAC resulting in pulmonary embolism (PE). CASE

SUMMARY:

A 40-year-old healthy man presented with fever and cough. He tested positive for COVID-19 and was sent home to self-quarantine. His symptoms resolved and repeat COVID-19 testing returned negative. Two months later, he developed dyspnoea on exertion and syncope. Computed tomography with PE protocol demonstrated acute bilateral PE, and repeat COVID-19 testing returned positive. He was escalated to catheter-directed thrombolysis, but prior to the procedure went into cardiopulmonary arrest. Cardiopulmonary resuscitation was initiated and full-dose systemic alteplase was administered. Cardiothoracic surgery was consulted for consideration of veno-arterial extracorporeal membrane oxygenation; however, return of spontaneous circulation was unable to be achieved.

DISCUSSION:

This case raises the question of COVID-19 reinfection and prolonged risk of VTE due to CAC. We believe the patient was reinfected with COVID-19 provoking his PE; however, a single COVID-19 infection causing a prolonged course of CAC is possible. Until better data exists, decisions regarding outpatient prophylaxis must be individualized to weigh the risks of bleeding against the risk of thrombosis.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Prognostic study Language: English Journal: Eur Heart J Case Rep Year: 2021 Document Type: Article Affiliation country: Ehjcr

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Case report / Prognostic study Language: English Journal: Eur Heart J Case Rep Year: 2021 Document Type: Article Affiliation country: Ehjcr