Case of right ventricular and aortic thrombi in a patient with severe COVID-19. Issue 4 (19th April 2021)

• Record Type: Journal Article
• Authors: Afari, Henrietta; Tefera, Leben; Rosovsky, Rachel P
• Is Part Of: BMJ case reports. Volume 14:Issue 4(2021)
• Publication Date: 2021-04-19
• Subjects: COVID-19 -- haematology (incl blood transfusion) -- venous thromboembolism; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2020-240745
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : Emerging evidence suggests that novel COVID-19 is associated with increased prothrombotic state and risk of thromboembolic complications, particularly in severe disease. COVID-19 is known to predispose to both venous and arterial thrombotic disease. We describe a case of a 61-year-old woman with history of type II diabetes, hypertension and hyperlipidaemia who presented with dry cough and acute abdominal pain. She was found to have a significantly elevated D-dimer, prompting imaging that showed thrombi in her right ventricle and aorta. She had rapid clinical deterioration and eventually required tissue plasminogen activator with subsequent durable clinical improvement. This case highlights a rare co-occurrence of venous and arterial thrombi in a patient with severe COVID-19. Further studies are needed to clarify the molecular mechanism of COVID-19 coagulopathy, the utility of D-dimer to predict and stratify risk of thrombosis in COVID-19, and the use of fibrinolytic therapy in patients with COVID-19.