Acute Mesenteric Ischemia in COVID-19 While Receiving Prophylactic Enoxaparin

Area of Science:

• Internal Medicine
• Cardiology
• Vascular Surgery

Background:

• COVID-19 is associated with increased risk of thromboembolic events.
• Hospitalized COVID-19 patients typically receive prophylactic anticoagulation.
• Risk factors for thrombosis include obesity, hyperlipidemia, and hypertension.

Observation:

• A 71-year-old woman with COVID-19 pneumonia developed acute mesenteric ischemia and pulmonary embolism.
• These events occurred despite receiving high-dose prophylactic enoxaparin (40 mg twice daily).

Findings:

• COVID-19-associated acute mesenteric ischemia is a rare but highly fatal complication.
• Standard prophylactic anticoagulation may be insufficient in some high-risk COVID-19 patients.

Implications:

• Early recognition and surgical intervention are critical for managing acute mesenteric ischemia.
• This case raises questions about the optimal anticoagulation strategy for high-risk COVID-19 patients, potentially necessitating therapeutic anticoagulation.