LaFree Andrew, Lenz Alexis, Tomaszewski Christian, Quenzer Faith
University of California, San Diego, Department of Emergency Medicine, San Diego, California.
Clin Pract Cases Emerg Med. 2021 Feb;5(1):17-21. doi: 10.5811/cpcem.2020.11.49593.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for the coronavirus disease of 2019 (COVID-19) pandemic, has been associated with a variety of prothrombotic sequelae. The pathogenesis of this hypercoagulability has not yet been fully elucidated, but it is thought to be multifactorial with overactivation of the complement pathways playing a central role. There is emerging evidence that the resulting complications are not confined to the venous circulation, and even in patients without typical respiratory symptoms or traditional risk factors, there is a significant rate of arterial thromboembolic disease in patients with SARS-CoV-2 infection.
We describe a patient presenting with bilateral leg pain without any respiratory symptoms or fever who ultimately was found to be COVID-19 positive and had thromboembolism of the aorta and bilateral iliac occlusion. This report reviews available evidence on the prevalence of arterial thromboembolism in COVID-19 patients and some proposed mechanisms of the pathophysiology of COVID-19-associated coagulopathy.
It is important that the emergency physician maintain a high degree of suspicion for arterial thromboembolic disease in patients who are infected with COVID-19 even in the absence of typical respiratory symptoms. Additionally, COVID-19 should be considered in patients with unexplained thromboembolic disease, as this may increase the detection of COVID-19.
导致2019年冠状病毒病（COVID-19）大流行的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）与多种血栓形成后遗症有关。这种高凝状态的发病机制尚未完全阐明，但认为是多因素的，补体途径的过度激活起核心作用。越来越多的证据表明，由此产生的并发症不仅限于静脉循环，即使在没有典型呼吸道症状或传统危险因素的患者中，SARS-CoV-2感染患者的动脉血栓栓塞性疾病发生率也很高。
我们描述了一名患者，其出现双侧腿痛，无任何呼吸道症状或发热，最终被发现COVID-19呈阳性，并有主动脉血栓栓塞和双侧髂动脉闭塞。本报告回顾了关于COVID-19患者动脉血栓栓塞患病率的现有证据以及一些提出的COVID-19相关凝血病病理生理学机制。
重要的是，即使在没有典型呼吸道症状的情况下，急诊医生也应对感染COVID-19的患者高度怀疑动脉血栓栓塞性疾病。此外，对于原因不明的血栓栓塞性疾病患者，应考虑COVID-19，因为这可能会增加COVID-19的检出率。
