Table 1.
Four cases of post COVID-19 acute arterial thromboses
| No | Age | Ethnic group | Sex | Presentation | Arterial events and co-morbidities | Imaging | SARS-CoV total antibody | SARS-CoV PCR | Date of arterial event | Days from positive serology to thrombosis | Treatment | Initial haemostatic assessment | Repeat haemostatic assessment | Current status |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 38 | Indian | M |
Fall with Acute right sided weakness Global aphasia NIHSS: 23 |
Acute left MCA infarct No comorbidities |
MRI brain Diffuse loss of grey-white differentiation and restricted diffusion involving the left fronto-parieto-temporal lobes and left basal ganglia |
Positive × 1 27 May |
Not tested | 7 July | 41 days |
1.IV rtPA 2.Endovascular therapy 3. Aspirin |
PT 13.5 APTT 26.4 D-dimer 3.20 Fibrinogen 2.7 vWF 260% Factor VIII NA Platelets 227 |
22 July > 3 Aug > 7 Oct PT 14.3 > 13.5 > 13.3 APTT 28.8 > 31.1 > 27.1 D-dimer 3.39 > 1.22 > 0.46 Fibrinogen 7.5 > 5.6 > 3.3 vWF 272% > 240% > 186% Factor VIII 208% (7 Oct) Platelets 583 > 369 > 256 |
71 days in Rehabilitation |
| 2 | 39 | Indian | M |
Acute right sided weakness Global aphasia NIHSS: 25 |
Left MCA and PCA infarct Pulmonary Embolism Infrarenal aortic thrombus Newly diagnosed DM |
MRI brain Large area of restricted diffusion is noted in the left fronto-parieto-temporal lobes, the left occipital and posterior medial temporal lobes CT pulmonary angiogram Thrombi seen in the right lower lobe, left upper lobe, left lower lobar, segmental and segmental branches. The main pulmonary arteries have no filling defects seen CT abdomen/pelvis Eccentric mural thrombus in the infrarenal aorta |
Positive × 2 21 May 14 Aug |
Negative × 2 20 Aug 21 Aug |
5 Aug | 76 days |
1.Thrombectomy 2.Craniectomy 3.Low molecular weight heparin with bridging to warfarin |
PT 13.7 APTT 26.6 D-dimer 3.55 Fibrinogen 5.8 vWF 226% Factor VIII 238% Platelets 301 |
30 Sept PT 30.9 APTT 38.4 Fibrinogen 4.7 vWF 153% Factor VIII 217% Platelets 256 |
30 days in Rehabilitation |
| 3 | 49 | Indian | M | Left acute painful lower limb |
Left acute ischaemic limb Infrarenal aortic thrombus No comorbidities |
CT angiography Occlusion of the left popliteal artery extending to tibioperoneal trunk and into the origins of the ATA, PTA and peroneal arteries. Aetiology is likely an embolus from the distal aorta/left common iliac artery |
Positive × 1 3 June |
Negative × 3 12 May 21 May 2 Sept |
2 Sept | 91 days |
1.Thrombectomy 2.IV Heparin followed by Rivaroxaban |
PT 13.1 APTT 26.7 D-dimer 0.42 Fibrinogen NA Factor VIII 216% vWF 161% Platelets 256 |
Not assessed yet as thrombotic event was recent | Discharged Home Well |
| 4 | 38 | Indian | M | Chest pain and sudden collapse |
ST-Elevation myocardial infarction No comorbidities |
Coronary angiogram 1. Dominance—Right-dominant 2. LM—Free of significant disease 3. LAD—Ostial LAD occluded 4. LCx—Normal 5. Ramus intermedius ( RI)—Normal 6. RCA – Normal |
Positive × 1 9 July Negative × 1 29 May |
Negative × 4 24 June 27 Sept 28 Sept 3 Oct |
27 Sept | 80 days |
1.PCI with drug eluting stent to LAD 2. Intraaortic balloon pump 3. Heparin 4. Aspirin 5. Ticagrelor |
PT 15.7 APTT 31.8 D-dimer 4.11 Fibrinogen 5.2 vWF 374% Platelets 156 |
Not assessed yet as thrombotic event was recent | Admitted to cardiac intensive care unit |
NIHSS National Institutes of Health Stroke Scale, MCA middle cerebral artery, PCA posterior cerebral artery, MRI magnetic resonance imaging, IV rTPA intravenous recombinant tissue plasminogen activator, CT computer tomography, DM diabetes mellitus, LM left main, LAD left anterior descending artery, LCx left circumflex artery, RCA right coronary artery, PCI percutaneous coronary intervention, NA not available
Prothrombin Time (PT): 11.7–14.0 s. Activated partial thromboplastin time (aPTT): 27.0–37.0 s. Fibrinogen: 1.8–4.5 g/L. D-Dimer: < 0.5 μg/ml. Platelets: 150–360 × 109/L. Factor VIII: 60–150%. Von Willebrand Factor (vWF): 56–160%