Belarbi Zakariae, Brem Falmata Laouan, El Ouafi Noha
Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco.
Epidemiological Laboratory of Clinical Research and Public Health, Oujda, Morocco.
Ann Med Surg (Lond). 2022 May;77:103485. doi: 10.1016/j.amsu.2022.103485. Epub 2022 Apr 2.
The COVID-19 infection induces coagulation dysfunction resulting in an increased incidence of pulmonary embolism (PE) and deep venous thrombosis (DVT), mostly in the lower extremities. While upper-extremity DVT is less frequent than lower-extremity DVT, the thrombosis of internal jugular vein or brachiocephalic (innominate) vein is an uncommon presentation. All the current studies concerning the thrombotic risk linked to hospital COVID-19 indicate that therapeutic anticoagulation does not improve the clinical prognosis in the intensive care unit. Standard prophylactic anticoagulation is therefore recommended. But again, thrombotic complications of COVID-19 infection are still frequently reported nowadays despite anticoagulation therapy, as we can see in this case report. Here we report a rare case of a 50-year-old woman with a previous history of dyslipidemia, admitted for COVID-19 related acute respiratory failure. The patient developed during hospitalization an acute bilateral PE, with upper-extremity DVT including thrombosis of the left brachiocephalic vein extended to the left internal jugular vein, while under prophylactic anticoagulation since hospital admission, leading finally to the patient's death from respiratory failure. At present, the pathophysiology of the hypercoagulable state related to COVID-19 infection is poorly understood. The significant rate of thrombosis despite preventive and therapeutic dosage anticoagulation raises the possibility of a pathophysiology unique to COVID-19. This rare case highlights the importance of thrombotic morbidity and mortality associated with the SARS-CoV-2 epidemic, and the need for further studies to better understand the physiopathology behind the thrombotic state of COVID 19 infection and establish a more efficient way to deal with these complications.
新型冠状病毒肺炎（COVID-19）感染会引发凝血功能障碍，导致肺栓塞（PE）和深静脉血栓形成（DVT）的发生率增加，其中大部分发生在下肢。虽然上肢DVT比下肢DVT少见，但颈内静脉或头臂（无名）静脉血栓形成是一种不常见的表现。目前所有关于与医院内COVID-19相关的血栓形成风险的研究表明，在重症监护病房进行治疗性抗凝并不能改善临床预后。因此，建议进行标准的预防性抗凝。但尽管如此，如今仍经常报道COVID-19感染的血栓形成并发症，正如我们在本病例报告中所见。在此，我们报告一例罕见病例，一名50岁女性，既往有血脂异常病史，因COVID-19相关急性呼吸衰竭入院。该患者在住院期间发生急性双侧肺栓塞，并伴有上肢DVT，包括左头臂静脉血栓形成并延伸至左颈内静脉，而自入院以来一直在进行预防性抗凝治疗，最终患者因呼吸衰竭死亡。目前，与COVID-19感染相关的高凝状态的病理生理学尚不清楚。尽管使用了预防性和治疗性剂量的抗凝药物，但血栓形成的发生率仍然很高，这增加了COVID-19独特病理生理学的可能性。这个罕见病例凸显了与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫情相关的血栓形成发病率和死亡率的重要性，以及进一步研究以更好地理解COVID-19感染血栓状态背后的病理生理学并建立更有效处理这些并发症方法的必要性。
