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COVID-19 Associated Coagulopathy in the Setting of Underlying Malignancy
Su Lin Lim1, Kok Hoe Chan1, Jihad Slim2
1Internal Medicine, Saint Michael's Medical Center, Newark, USA.
Insights
COVID-19 coagulopathy can cause dangerous blood clots like deep vein thrombosis (DVT) and pulmonary embolism (PE), even during anticoagulation therapy. This case highlights the unpredictable nature of COVID-19
Area of Science:
- Hematology
- Oncology
- Infectious Diseases
Background:
- COVID-19 is associated with coagulopathy, increasing risks of deep vein thrombosis (DVT) and pulmonary embolism (PE).
- Current guidelines for therapeutic anticoagulation in COVID-19 patients are lacking.
- Metastatic malignancies present a known thrombophilic state.
Observation:
- A confirmed COVID-19 patient with metastatic ovarian cancer developed DVT and PE.
- The patient was already receiving therapeutic anticoagulation at the time of presentation.
Findings:
- This case demonstrates the unpredictable and severe coagulopathy associated with COVID-19.
- COVID-19 may exacerbate the inherent thrombophilic state in patients with metastatic cancer.
Implications:
- Highlights the challenges in managing anticoagulation for COVID-19 patients due to a lack of evidence-based guidelines.
- Suggests a potential synergistic effect between COVID-19 and malignancy on thrombogenesis.
- Emphasizes the need for individualized treatment strategies in complex cases.
Abstract:
Coronavirus disease 2019 (COVID-19) associated coagulopathy is a well-recognized predictor for morbidity and mortality in COVID-19 patients. Both deep vein thrombosis (DVT) and pulmonary embolism (PE) have been reported in COVID-19 patients. Nonetheless, there are no consensus guidelines on the use of therapeutic coagulation in this group of patients. We herein present a unique case of a confirmed COVID-19 patient with metastatic ovarian cancer who presented with DVT and PE despite being on therapeutic anticoagulation, highlighting the unpredictability of COVID-19 associated coagulopathy. This case study raises the awareness that the thrombophilic state in metastatic malignancies is potentially augmented by COVID-19. We also discuss the complexity of making anticoagulation treatment decision in COVID-19 patients in the absence of evidence-based guidelines.
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