Aoi Shunsuke, Kakkar Amit M, Golowa Yosef, Grushko Michael, Coyle Christina M, Elrafei Tarek, Langston Matthew D, Faillace Robert T, Bangalore Sripal, Sokol Seth I
Department of Medicine/Cardiology, New York City Health + Hospitals Corporation, Jacobi Medical Center 1400 Pelham Parkway, Bronx, NY 10461, USA.
Department of Radiology, Montefiore Medical Center 111 E 210th St, Bronx, NY 10467, USA.
Eur Heart J Case Rep. 2020 Dec 7;4(6):1-6. doi: 10.1093/ehjcr/ytaa437. eCollection 2020 Dec.
Coronavirus disease 2019 (COVID-19) is associated with a coagulopathy favouring thrombosis over bleeding that imparts a poor prognosis. Clot in transit (CIT) is considered a rare entity and the most severe form of venous thromboembolism (VTE), carrying a higher mortality than isolated pulmonary embolism (PE). The incidence of this phenomenon in patients with COVID-19 infection is unknown and likely under-recognized.
During the peak of the COVID-19 pandemic in New York City, a 70-year-old Hispanic female presented with syncope due to a saddle PE further complicated by a highly mobile CIT. Polymerase chain reaction was positive for COVID-19 infection, however, there was no evidence of lung parenchymal involvement or hyper-inflammation. Based on consensus from a multidisciplinary team, aspiration thrombectomy was attempted to treat this extreme case of VTE, however, the patient died during the procedure.
This case raises awareness to the most catastrophic form of VTE, presenting in an early phase of COVID-19 infection without the typical hyper-inflammation and severe lung injury associated with development of COVID-related coagulopathy. It also serves to inform on the critical role echocardiography has in the comprehensive evaluation and re-evaluation of hospitalized patients with COVID-19, and the importance of a multidisciplinary organized approach in clinical decision-making for this complex and poorly understood disease and its sequelae.
2019冠状病毒病（COVID-19）与一种凝血功能障碍有关，这种障碍更易引发血栓形成而非出血，从而导致预后不良。移行性血栓（CIT）被认为是一种罕见的病症，也是静脉血栓栓塞症（VTE）最严重的形式，其死亡率高于单纯的肺栓塞（PE）。COVID-19感染患者中这种现象的发生率尚不清楚，且可能未得到充分认识。
在纽约市COVID-19大流行高峰期，一名70岁的西班牙裔女性因马鞍形肺栓塞伴高度移动性CIT而出现晕厥。聚合酶链反应检测显示COVID-19感染呈阳性，但没有肺实质受累或炎症反应过度的证据。基于多学科团队的共识，尝试采用抽吸血栓切除术治疗这例极端的VTE病例，但患者在手术过程中死亡。
该病例提高了人们对VTE最严重形式的认识，这种情况出现在COVID-19感染的早期阶段，没有与COVID-19相关凝血功能障碍发展相关的典型炎症反应过度和严重肺损伤。它还说明了超声心动图在COVID-19住院患者综合评估和重新评估中的关键作用，以及多学科组织方法在针对这种复杂且了解不足的疾病及其后遗症进行临床决策中的重要性。
