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Splenic infarct in a COVID-19 patient under anticoagulant therapy with normal D-dimer levels
Semra Demirli Atıcı1, Göksever Akpınar1
1University of Health Sciences Tepecik Training and Research Hospital, Department of General Surgery, Turkey.
Insights
COVID-19 can cause blood clots, even during anticoagulant treatment. A patient developed splenic infarction and myocardial infarction despite receiving low-molecular-weight heparin, highlighting potential risks of coagulopathy.
Area of Science:
- Cardiology
- Hematology
- Infectious Diseases
Background:
- COVID-19 is associated with coagulopathy and thrombotic events.
- Standard prophylactic doses of low-molecular-weight heparin (LMWH) may be insufficient for thrombosis prevention in hospitalized COVID-19 patients.
Observation:
- A 45-year-old male presented with abdominal pain nine days after a positive COVID-19 test.
- Despite LMWH treatment for COVID-19 pneumonia, he developed splenic infarction (SI) and later acute myocardial infarction (MI).
- Abdominal CT confirmed SI; ECG revealed acute anterior MI.
Findings:
- Splenic infarction and acute myocardial infarction occurred despite anticoagulant therapy.
- Leukocytosis was noted, but d-dimer levels were normal.
Implications:
- Abdominal-visceral thromboembolism should be considered in COVID-19 patients with abdominal pain, even with normal d-dimer.
- Current prophylactic LMWH doses may not adequately prevent coagulopathy in all hospitalized COVID-19 patients.
Background:
Many studies have shown that COVID-19 can progress with coagulopathy and multisystemic thrombotic events. We report a patient who presented with abdominal pain after COVID-19 and was found to have splenic infarction (SI) concomitant with acute myocardial infarctus (MI) under anticoagulant treatment.
Case Presentation:
A 45-year-old man was admitted to the emergency department with left-sided abdominal pain radiating through to his back persisting for one day. He had COVID-19 PCR positivity nine days ago. After seven days of hospitalization due to COVID-19 pneumonia, he had been discharged with low-molecular-weight heparin (LMWH). Abdominal computerized tomography (CT) showed SI. His ECG and laboratory parameters were normal except for 17.2 × 10∧3/μL leukocytosis. The anticoagulant drug dose that he was taking was increased to 2 × 0.6 mL during hospitalization. He described new-onset chest pain during follow-up. Acute anterior MI was detected on ECG. Successful percutaneous coronary angiography was performed by cardiologists. No problems were observed in the follow-up. The patient was discharged on the fifth day of conservative treatment due to splenic infarction.
Conclusion:
Thrombosis prophylaxis with prophylactic doses of LMWH in hospitalized COVID-19 patients may not be sufficient to prevent the development of coagulopathy in patients. Abdominal-visceral thromboembolism should be suspected in a COVID-19-positive patient presenting with abdominal pain despite receiving anticoagulant therapy and normal d-dimer levels.
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