Amaqdouf Saîda, Belarbi Zakariae, Beghi Mustapha, Toutai Chaimae, Ismaili Nabila, El Ouafi Noha
Department of Cardiology, Mohammed VI University Hospital of Oujda, Mohammed First University of Oujda, Morocco.
Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco.
Ann Med Surg (Lond). 2022 Jan;73:103090. doi: 10.1016/j.amsu.2021.103090. Epub 2021 Nov 27.
and importance: Pulmonary embolism (PE) is still a major health concern around the world, and its link with SARS Cov-2 has led to an increase in morbidity, mortality, and ICU hospitalizations.
We present the case of a 92-year-old man with no prior medical history who admitted to our hospital in a state of acute respiratory failure, echocardiography revealed an acute right heart syndrome with a thrombus in the right atrium, computed tomography pulmonary angiogram revealed bilateral massive pulmonary embolism as well as Covid-19 pneumonia. He was treated with systemic thrombolysis using intravenous rt-PA (recombinant tissue plasminogen activator) with immediate clinical improvement and no hemorrhagic complications.
In the presence of the SARs Cov-2 infection, several reports have indicated considerable procoagulant events, including life-threatening pulmonary embolism. There are still no current guidelines for the treatment of VTE in COVID-19 patients, but they are largely consistent with non-COVID-19 recommendations. Elderly patients are considered to be at high risk of developing thromboembolic complications, and also and above all are vulnerable to bleeding complications from anticoagulant treatments.
This case highlight the importance of considering thromboembolic complications despite the severity of the associated SARS-cov-2 pneumonia and the role of prophylactic anticoagulation for Covid-19 patients hospitalized or not.
及重要性：肺栓塞（PE）仍是全球主要的健康问题，其与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的关联导致发病率、死亡率及重症监护病房（ICU）住院率上升。
我们报告一例92岁男性患者，既往无病史，因急性呼吸衰竭入院。超声心动图显示急性右心综合征，右心房有血栓形成；计算机断层扫描肺动脉造影显示双侧大面积肺栓塞以及新型冠状病毒肺炎（Covid-19肺炎）。给予静脉注射重组组织型纤溶酶原激活剂（rt-PA）进行全身溶栓治疗，患者临床症状立即改善，且未出现出血并发症。
在感染SARS-CoV-2的情况下，多项报告表明存在相当多的促凝事件，包括危及生命的肺栓塞。目前仍没有针对新型冠状病毒肺炎（COVID-19）患者静脉血栓栓塞症（VTE）治疗的指南，但这些指南在很大程度上与非COVID-19患者的推荐意见一致。老年患者被认为发生血栓栓塞并发症的风险较高，而且最重要的是，他们容易因抗凝治疗而出现出血并发症。
本病例强调，尽管相关的SARS-CoV-2肺炎病情严重，但仍需考虑血栓栓塞并发症，以及预防性抗凝对住院或未住院的COVID-19患者的作用。
