COVID-19 - Thrombolysis For Acute Limb Ischaemia

ABSTRACT

Introduction: It is now well established that COVID-19 is linked to acute thrombosis. We present a case of an intubated and ventilated patient who received thrombolysis for acute limb ischemia. Shortly after intubation for respiratory failure secondary to COVID-19, a patient in their 50s developed a cold pulse less hand which was reviewed by vascular surgeons and radiologically diagnosed as acute arterial thrombosis resulting in an ischaemic hand. Objectives: Provide evidence for the use of systemic thrombolysis to treat thrombotic complications of COVID-19. Methods: Different treatment modalities were discussed within the multidisciplinary team. It was decided that the patient was unstable for transfer to theatre as he was in the proned position with severe respiratory failure. Therefore, systemic thrombolysis was administered to the patient twice over a period of 24 hours. Results: Following administration of Alteplase the patient went on to recover perfusion to the hand as well as making a remarkable respiratory improvement. This allowed for extubation within a matter of days. The patient survived to discharge without functional limitation of the hand. 6 months post discharge the patient is working full time in a manual capacity. Conclusions: We provide evidence that systemic thrombolysis can be considered as an option for acute limb ischemia in ventilated patients with COVID-19 for which conventional treatment options are not viable. With the knowledge that COVID-19 is a prothrombotic illness, it is possible that the thrombolysis of intercurrent pulmonary emboli contributed to respiratory recovery.