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Case of right ventricular and aortic thrombi in a patient with severe COVID-19

Henrietta Afari1, Leben Tefera2, Rachel P Rosovsky3

  • 1Hospital Medicine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA hafari@partners.org.

BMJ Case Reports
|April 20, 2021
PubMed

Insights

Severe COVID-19 can cause dangerous blood clots in both veins and arteries. This case report details a rare instance of combined venous and arterial thrombosis in a diabetic patient, emphasizing the need for further research.

Area of Science:

  • Cardiology
  • Hematology
  • Infectious Diseases

Background:

  • COVID-19 is increasingly linked to a prothrombotic state.
  • The virus can lead to both venous and arterial thromboembolic complications, especially in severe cases.

Observation:

  • A 61-year-old woman with diabetes, hypertension, and hyperlipidemia presented with cough and abdominal pain.
  • Elevated D-dimer levels were detected, leading to imaging that revealed right ventricle and aortic thrombi.

Findings:

  • The patient experienced rapid clinical deterioration.
  • Treatment with tissue plasminogen activator resulted in significant clinical improvement.
  • This case illustrates a rare co-occurrence of venous and arterial thrombosis in severe COVID-19.

Implications:

  • Further research is required to understand the mechanisms of COVID-19 coagulopathy.
  • The role of D-dimer in predicting and stratifying thrombosis risk in COVID-19 patients needs clarification.
  • The efficacy of fibrinolytic therapy for COVID-19-associated thrombosis warrants investigation.

Keywords:
COVID-19haematology (incl blood transfusion)venous thromboembolism

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