Yarlagadda Keerthi, Mi Kaihong, Sendil Selin, Koons Connie L, Komanduri Saketram, Cinicola John T
Department of Internal Medicine, University of Pittsburgh Medical Center (UPMC) Pinnacle, Harrisburg, PA, USA.
Department of Hematology and Oncology, Pinnacle Health Hematology and Oncology, Harrisburg, PA, USA.
Am J Case Rep. 2020 Aug 18;21:e926623. doi: 10.12659/AJCR.926623.
BACKGROUND COVID-19 was declared a pandemic in March 2020 in the United States. It has been associated with high mortality and morbidity all over the world. COVID-19 can cause a significant inflammatory response leading to coagulopathy and this hypercoagulable state has been associated with worse clinical outcomes in these patients. The published data regarding the presence of lupus anticoagulant in critically ill COVID-19-positive patients is limited and indicates varying conclusions so far. CASE REPORT Here, we present a case of a 31-year-old man who was admitted to the hospital with COVID-19 pneumonia, complicated with superadded bacterial empyema and required video-assisted thoracoscopic surgery with decortication. This patient also had prolonged prothrombin time on preoperative labs, which was not corrected with mixing study. Further workup detected positive lupus anticoagulant and anti-cardiolipin IgM along with alteration in other coagulation factor levels. The patient was treated with fresh frozen plasma and vitamin K before surgical intervention. He had an uneventful surgical course. He received prophylactic-dose low molecular weight heparin for venous thromboembolism prophylaxis and did not experience any thrombotic events while hospitalized. CONCLUSIONS COVID-19 infection creates a prothrombotic state in affected patients. The formation of micro-thrombotic emboli results in significantly increased mortality and morbidity. Routine anticoagulation with low molecular weight heparin can prevent thrombotic events and thus can improve patient outcomes. In patients with elevated prothrombin time, lupus anticoagulant/anti-cardiolipin antibody-positivity should be suspected, and anticoagulation prophylaxis should be continued perioperatively for better outcomes.
背景 2020 年 3 月，新型冠状病毒肺炎（COVID - 19）在美国被宣布为大流行病。它在全球范围内都与高死亡率和高发病率相关。COVID - 19 可引发显著的炎症反应，导致凝血病，这种高凝状态与这些患者更差的临床结局相关。关于重症 COVID - 19 阳性患者中狼疮抗凝物存在情况的已发表数据有限，且目前显示出不同的结论。病例报告 在此，我们呈现一例 31 岁男性患者，因 COVID - 19 肺炎入院，并发叠加细菌性脓胸，需要进行电视辅助胸腔镜手术及纤维板剥脱术。该患者术前实验室检查还显示凝血酶原时间延长，且混合试验未能纠正。进一步检查发现狼疮抗凝物和抗心磷脂 IgM 阳性，同时其他凝血因子水平也有改变。患者在手术干预前接受了新鲜冰冻血浆和维生素 K 治疗。他的手术过程顺利。他接受了预防剂量的低分子量肝素以预防静脉血栓栓塞，住院期间未发生任何血栓事件。结论 COVID - 19 感染在受影响患者中产生促血栓形成状态。微血栓栓塞的形成导致死亡率和发病率显著增加。常规使用低分子量肝素抗凝可预防血栓事件，从而改善患者结局。对于凝血酶原时间升高的患者，应怀疑狼疮抗凝物/抗心磷脂抗体阳性，围手术期应持续进行抗凝预防以获得更好的结局。
