Hospital Medicine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
Harrington Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
BMJ Case Rep. 2021 Apr 19;14(4):e240745. doi: 10.1136/bcr-2020-240745.
Emerging evidence suggests that novel COVID-19 is associated with increased prothrombotic state and risk of thromboembolic complications, particularly in severe disease. COVID-19 is known to predispose to both venous and arterial thrombotic disease. We describe a case of a 61-year-old woman with history of type II diabetes, hypertension and hyperlipidaemia who presented with dry cough and acute abdominal pain. She was found to have a significantly elevated D-dimer, prompting imaging that showed thrombi in her right ventricle and aorta. She had rapid clinical deterioration and eventually required tissue plasminogen activator with subsequent durable clinical improvement. This case highlights a rare co-occurrence of venous and arterial thrombi in a patient with severe COVID-19. Further studies are needed to clarify the molecular mechanism of COVID-19 coagulopathy, the utility of D-dimer to predict and stratify risk of thrombosis in COVID-19, and the use of fibrinolytic therapy in patients with COVID-19.
新出现的证据表明，新型冠状病毒病与促血栓形成状态和血栓栓塞并发症的风险增加有关，特别是在重症疾病中。新型冠状病毒病已知可导致静脉和动脉血栓形成性疾病。我们描述了一例 61 岁女性病例，有 2 型糖尿病、高血压和高脂血症病史，表现为干咳和急性腹痛。她的 D-二聚体显著升高，促使进行影像学检查，显示其右心室和主动脉有血栓。她的病情迅速恶化，最终需要使用组织型纤溶酶原激活物，随后临床状况持续改善。该病例突出了 COVID-19 重症患者中罕见的静脉和动脉血栓同时发生的情况。需要进一步的研究来阐明 COVID-19 凝血功能障碍的分子机制、D-二聚体在预测和分层 COVID-19 血栓形成风险中的作用，以及在 COVID-19 患者中使用纤维蛋白溶解治疗的作用。
