Castro-Verdes Mireya, Gkouma Antonia, Wort John, Ridge Carole, Mirsadraee Saeed, Padley Simon, Sheikh Awais, Singh Suveer
Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
Eur Heart J Case Rep. 2020 Dec 12;4(6):1-7. doi: 10.1093/ehjcr/ytaa470. eCollection 2020 Dec.
Corona Virus Disease 2019 (COVID-19) pneumonitis associated with severe respiratory failure carries a high mortality. Coagulopathy has emerged as a significant contributor to thrombotic complications.
We describe two cases of severe COVID-19 pneumonitis refractory to conventional mechanical ventilation and proning position, transferred to our specialist centre for cardiorespiratory failure. Cross-sectional imaging demonstrated concurrent venous and aortic thrombosis with end-organ ischaemic changes. One patient received thrombolysis with a partial response. This could not be offered to the other patient due to a recent haemorrhagic event. Both patients died of multi-organ failure in the hospital.
Concurrent aortic and venous thromboses are rare. This finding in COVID-19 cases, who were both critically ill patients, likely reflects the strongly thrombogenic nature of this illness which ultimately contributed to poor outcomes. The absence of deep vein thrombosis or a potential systemic source of embolism suggests thrombosis. Further, the management of anticoagulation and thrombolysis is challenging in patients where an attendant bleeding risk exists.
2019年冠状病毒病（COVID-19）肺炎合并严重呼吸衰竭死亡率很高。凝血病已成为血栓形成并发症的一个重要因素。
我们描述了两例严重COVID-19肺炎患者，常规机械通气和俯卧位治疗无效，转至我们的心肺衰竭专科中心。横断面成像显示同时存在静脉和主动脉血栓形成以及终末器官缺血性改变。一名患者接受了溶栓治疗，部分有效。由于近期发生出血事件，另一名患者无法接受溶栓治疗。两名患者均在医院死于多器官衰竭。
主动脉和静脉同时发生血栓形成很少见。在这两名危重症COVID-19患者中出现这一发现，可能反映了该疾病强烈的血栓形成倾向，最终导致了不良预后。未发现深静脉血栓形成或潜在的全身栓塞源提示存在原位血栓形成。此外，在存在出血风险的患者中，抗凝和溶栓治疗具有挑战性。
