Arterial thrombosis in a patient with coronavirus disease

Background: Since the emergence of the COVID-19 pandemic, there is an increasing evidence that affected patients have a higher incidence of thrombotic complications than the general population This coagulopathy appears to be responsible for venous and less commonly arterial thromboembolic complications, in up to 50% of COVID-19 patients with severe manifestations Abnormal coagulation parameters are considered a warning sign of such complications The COVID-19 patients\u0027 laboratory findings include thrombocytopenia, elevated D-dimer levels, prolonged prothrombin time and disseminated intravascular coagulation However, the exact underlying mechanism is not yet well understood The evolution is rarely favorable on anticoagulant and anti-aggregating therapy, as in the case reported below Case report: We report herein a case of aortic thrombosis in a 77-year-old patient with a history of hypertension and atrial fibrillation on Vitamin K antagonist (VKA), who presented to the emergency department with dyspnoea and abdominal pain On examination, he was hemodynamically stable, but polypneic and hypoxic with 76% SpO2 in ambient air, his abdomen was painful on palpation The ECG showed atrial fibrillation at 100 bpm without any repolarization disorder He had lymphopenia, a prominent elevation of D-dimer rate at 26810ng/ml and fibrin/fibrinogen degradation products at 5 19 g/l, as well as over dosage in VKA with INR at 20, without abnormalities in platelet counts COVID-19 pneumonia was confirmed by RT-PCR test and CT (Figure1) showed bilateral ground glass opacities (70% lung injury) Since the patient presented with abdominal pain, abdominal CT scan was performed, showing a non-obstructive abdominal aortic thrombosis: two pedunculated endoluminal thrombi based on parietal implantation at T9 and T11 stenosing the lumen by approximately 45-50% (Figure2), as well as large areas of splenic infarction (Figure3) and cortical lesions of the left kidney, suggesting renal infarction sites (Figure4) Patient was treated with therapeutic anticoagulation associated to aspirin, with a good initial result One-month follow-up shows no complications Conclusion: Our knowledge of this emerging human pathogen is rapidly progressing, and our understanding of management strategies to optimize outcomes in affected patients is evolving This case supports the hypercoagulability state in COVID-19 and enhances the recommendation to use pharmacological prophylaxis of thrombosis