Desdiani Desdiani
Faculty of Medicine, Universitas Sultan Ageng Tirtayasa, Cilegon, Banten, Indonesia.
Department of Pulmonology and Respiratory Medicine, Bhayangkara Brimob Hospital, Cimanggis, Depok, West Java, Indonesia.
Can J Respir Ther. 2022 Apr 20;58:49-52. doi: 10.29390/cjrt-2021-028. eCollection 2022.
Late diagnosis of COVID-19 in young patients in a hypercoagulable state can cause a high mortality rate. Clinical manifestations of COVID-19 include respiratory and extrapulmonary symptoms such as a hypercoagulable state, increased transaminase enzymes, and multiple-organ failure.
A 34-year-old male presented to the emergency room after 3 days of high fever, weakness, and flatulence. The patient had thrombocytopenia and elevated liver transaminase enzymes and was initially diagnosed with dengue hemorrhagic fever. He was given hydration intravenous fluids, oxygen, antipyretic, and hepatoprotector. On day 4, the patient was diagnosed with COVID-19 and received therapy to decrease the Alanine transaminase and Aspartate transaminase levels. While waiting for outsourced D dimer and prothrombin time results, the patient was given low molecular weight heparin (LMWH) on day 5. On day 13, his condition deteriorated with cephalgia and shortness of breath, but the patient's family refused intubation. The chest CT scan revealed large ground-glass opacities in both lungs. The patient was given additional medications, such as Meropenem, Dexamethasone, and Remdesivir. On day 15, the patient passed away.
Intermediate LMWH dosage seems to be associated with a lower mortality incidence than standard Deep Vein Thrombosis (DVT) prophylaxis in hospitalized COVID-19 patients. However, due to the late COVID-19 diagnosis, the patient was not given LMWH at the beginning of treatment.
A hypercoagulable state is partly responsible for the high mortality rate of COVID-19 patients. Early detection and management of the hypercoagulable state, including the use of LMWH, can decrease the severity of COVID-19 symptoms.
处于高凝状态的年轻COVID-19患者的延迟诊断可导致高死亡率。COVID-19的临床表现包括呼吸道和肺外症状，如高凝状态、转氨酶升高和多器官衰竭。
一名34岁男性在出现高热、虚弱和肠胃胀气3天后前往急诊室。该患者血小板减少且肝转氨酶升高，最初被诊断为登革出血热。给予其静脉补液、氧气、退烧药和肝保护剂。第4天，该患者被诊断为COVID-19，并接受了降低丙氨酸转氨酶和天冬氨酸转氨酶水平的治疗。在等待外包的D-二聚体和凝血酶原时间结果期间，第5天给该患者使用了低分子量肝素（LMWH）。第13天，他的病情恶化，出现头痛和呼吸急促，但患者家属拒绝插管。胸部CT扫描显示双肺有大片磨玻璃影。给该患者加用了其他药物，如美罗培南、地塞米松和瑞德西韦。第15天，患者去世。
在住院的COVID-19患者中，中等剂量的LMWH似乎比标准的深静脉血栓形成（DVT）预防措施导致的死亡率更低。然而，由于COVID-19诊断延迟,患者在治疗开始时未使用LMWH。
高凝状态是COVID-19患者高死亡率的部分原因。早期检测和处理高凝状态，包括使用LMWH，可以减轻COVID-19症状的严重程度。
