Arterial Thrombosis and Coronavirus Disease 2019

Prevalence of pre-existing peripheral artery disease in COVID-19 patients and relative mortality risk: Systematic review and meta-analysis

INTRODUCTION

This study aims to assess prevalence and prognostic implications of pre-existing peripheral artery disease (PAD) in patients infected by the SARS-CoV-2 by means of a systematic review and meta-analysis.

MATERIAL AND METHODS

We searched MEDLINE and Scopus to locate all the articles published up to 10 December 2021, reporting data on pre-existing PAD among COVID-19 survivors (S) and non survivors (NS). The pooled prevalence of pre-existing PAD in COVID-19 patients was calculated using a random effects model and presenting the related 95% confidence interval (CI), while the mortality risk was estimated using the Mantel-Haenszel random effects models with odds ratio (OR) and related 95% CI. Statistical heterogeneity was measured using the Higgins I2 statistic.

RESULTS

Eight investigations, enrolling 13,776 COVID-19 patients (mean age: 67.1 years, 3.863 males), met the inclusion criteria and were included in the final analysis. The pooled prevalence of pre-existing PAD was 5.7% of cases (95% CI: 3.8-8.4%, p < 0.0001), with high heterogeneity (I2 = 84.5%), which was directly correlated with age (p < 0.0001), previous hypertension (p = 0.003), and dyslipidaemia (p = 0.02) as demonstrated by the meta-regression. Moreover, pre-existing PAD was significantly associated with higher risk of short-term death in patients with SARS-CoV-2 infection (OR: 2.78, 95% CI: 2.37-3.27, p < 0.0001 I2 = 0%); the sensitivity analysis confirmed yielded results.

CONCLUSIONS

Pre-existing PAD represents a comorbidity in about 1 out of 6 COVID-19 patients, but it is associated with a twofold higher risk of short-term mortality.

Acute Aortic Syndrome in a patient with COVID-19

The global effects of the COVID-19 pandemic make it of the utmost importance to comprehend its mechanisms and define strategies for the most effective approach possible. The SARS-CoV-2 virus can be responsible for the induction of a hypercoagulable state, which can trigger vascular phenomena of venous etiology, specifically deep venous thrombosis or pulmonary embolism. Arterial thrombotic events associated with COVID-19 have also been described in the medical literature, although less frequently. In this paper the authors report the case of a 66-year-old man who was diagnosed with an Acute Aortic Syndrome, specifically an intramural thrombus on the aortic arch, while he was still infected with the virus. Anticoagulation with low weight molecular heparin was initiated and the patient was admitted at the Internal Medicine ward for a conservative therapeutic approach. The thrombus remained stable on a serial imaging evaluation; therefore, the patient was discharged with oral anticoagulation with subsequent follow-up in the outpatient clinic. This case describes a rare and potentially serious complication of COVID-19, which highlights how broad its clinical spectrum can be, affecting systems other than the pulmonary.

Accelerated LVAD pump thrombosis in COVID-19 patient: Case report and mini review

BACKGROUND

Coronavirus (COVID-19) infection exposes patients with heart failure specially who are on mechanical support to a higher risk of morbidity and mortality.

AIMS

To investigate the impact of COVID-19 infection on left ventricular assist device (LVAD) thrombosis in heart failure patients.

MATERIALS & METHODS

We searched the medical electronic records, Medline, PubMed and Cochrane databases for; (LVAD) AND (thrombosis)) AND (covid-19)) AND (heart failure). We divided cases reported into, LVAD thrombosis with COVID-19 infection and compare them with LVAD thrombosis without COVID-19 infection. Demographic data, LVAD device, presentation, treatment and outcomes were reviewed in all the LVAD thrombosis patients.

RESULTS

In addition to our case, 8 other cases of LVAD thrombosis associated with COVID and 9 cases of LVAD thrombosis without covid infection were found. Patients with Covid infection had worse presentation and outcomes (3 deaths VS. 1 death in non-covid group).

DISCUSSION

In LVAD patients, pump malfunction due to thrombus development in the inflow cannula, device body, or outflow graft can result in hemodynamic instability, hemolysis and other life-threatening complications. COVID infection significantly increases the risk of mortality in LVAD patient by accelerating the pump thrombosis due to elevated levels of endothelial protein C receptor and thrombomodulin along with procoagulants such as factor VIII, P-selectin, and von Willebrand factor.

CONCLUSION

Significant morbidity and mortality are attributed to LVAD thrombosis, which are exasperated by prothrombotic conditions created in COVID-19 infections.

Unusual Presentation of a Severe COVID-19 Case With Axillary Artery Thrombosis

The coronavirus disease 2019 (COVID-19) pandemic has been evolving since early 2020 with high critical care mortality and morbidity. High mortality rates have been linked largely to respiratory failure. Hypercoagulability status induced by the massive inflammatory storm has led to a high rate of thrombotic events, whether arterial or venous, contributing to COVID-19 mortality especially in critically ill patients. Thrombotic events might be the presenting feature of the disease or might happen during hospitalization. In this case report, we describe a case of a 67-year-old male with severe COVID-19 pneumonia who was found on presentation to have left axillary artery thrombosis requiring embolectomy; the case was managed successfully. We reviewed the pathophysiology of hypercoagulability associated with COVID-19, clinical implications, and most recent treatment recommendations.