Hashemi Arash, Gerges Fady, Naqvi Haseeb Raza, Kotlar Irina, Moscatelli Sara, Hashemi Ashkan, Rustamova Yasmin, Almaghraby Abdallah
Department of Cardiology, Erfan General Hospital, Tehran, Iran.
Department of Cardiovascular Science, Mediclinic Al Jowhara Hospital, P.O. box 84142, Al Ain, United Arab Emirates.
Egypt Heart J. 2021 May 1;73(1):39. doi: 10.1186/s43044-021-00162-9.
Novel coronavirus disease 2019 (COVID-19) is known to lead not only to severe acute respiratory syndrome, but also can result in thromboembolic events in both the venous and the arterial circulation by inducing coagulation disorders. The potential causes of coagulopathy are inflammation, platelet activation, endothelial dysfunction, and stasis. The thrombotic events including pulmonary embolism, deep venous thrombosis as well as intracatheter thrombosis are more likely to develop in patients infected with severe form of SARS-CoV-2 who are admitted to ICU. Furthermore, these events contribute to multi-organ failure.
Herein, we report a case of an immunocompromised COVID-19 elderly patient with acute lymphocytic leukemia who developed myocardial infarction with ST elevation in the setting of acute pulmonary thromboembolism in the presence of zero platelet count. Despite successful urgent coronary revascularization and platelet transfusion, the patient eventually died after failed resuscitation efforts.
Patients with COVID-19 infection are at a greater risk of developing cardiovascular complications, but their appropriate management can decrease the risk of fatal events. Coronary thrombosis associated with pulmonary thromboembolism in the setting of thrombocytopenia is a rare and a complex to manage condition. Significance of single antiplatelet agent in STEMI with thrombocytopenia merits further studies. According to expert opinions and literature reviews, we must avoid dual antiplatelet therapy in these patients and keep platelet transfusion as a standard therapy to avoid drastic bleeding complications.
已知2019年新型冠状病毒病（COVID-19）不仅会导致严重急性呼吸综合征，还可通过引发凝血障碍在静脉和动脉循环中导致血栓栓塞事件。凝血病的潜在原因包括炎症、血小板活化、内皮功能障碍和血流淤滞。包括肺栓塞、深静脉血栓形成以及导管内血栓形成在内的血栓事件更有可能在入住重症监护病房（ICU）的感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的患者中发生。此外，这些事件会导致多器官功能衰竭。
在此，我们报告一例免疫功能低下的COVID-19老年患者，该患者患有急性淋巴细胞白血病，在血小板计数为零的情况下，因急性肺血栓栓塞并发ST段抬高型心肌梗死。尽管紧急冠状动脉血运重建成功且输注了血小板，但患者在复苏努力失败后最终死亡。
COVID-19感染患者发生心血管并发症的风险更高，但对其进行适当管理可降低致命事件的风险。血小板减少情况下与肺血栓栓塞相关的冠状动脉血栓形成是一种罕见且难以处理的情况。单一抗血小板药物在血小板减少的ST段抬高型心肌梗死中的意义值得进一步研究。根据专家意见和文献综述，我们必须避免在这些患者中进行双联抗血小板治疗，并将血小板输注作为标准治疗方法，以避免严重出血并发症。
