Alemayehu Fikremariam Melkeneh, Huluka Dawit Kebede, Beyene Tizazu Kebede, Aboye Azmera Gissila, Mesfin Hiwotie Abebe
General Practitioner, Intensive Care Unit Trained, Ministry of Health (MOH) Eka Kotebe General Hospital, Addis Ababa, Ethiopia.
Internist, Pulmonologist, and Critical Care Subspecialist, Department of Internal Medicine, School of Medicine, Addis Ababa University, Ethiopia.
Thromb Update. 2023 Mar;10:100128. doi: 10.1016/j.tru.2022.100128. Epub 2022 Dec 30.
Hypercoagulability is a common complication seen in COVID-19 infection. However, arterial thrombosis such as acute limb ischemia (ALI) is far less common. Data on the incidence and nature of arterial thromboembolic complications in patients with COVID-19 is limited, originating from a few case reports and case series. Data in the African continent are very scarce.
This is a case series of 10 patients with COVID-19 who developed ALI while on treatment at Eka Kotebe General Hospital, Addis Ababa, Ethiopia. All patients with ALI and COVID-19 admitted between February 1, 2021, and December 31, 2021, were retrospectively identified and reviewed. COVID-19 was confirmed by RT-PCR and ALI was confirmed by Doppler ultrasound and/or computed tomography angiography in the presence of clinical suspicion.
A total of 3098 patients were hospitalized with confirmed COVID-19 during the study period. In a series of 10 patients, 8 (80%) males with a median age of 53.5 years were included. All except one (10%) had one or more risk factors for ALI and one had a 'possible' case of vaccine-induced thrombotic thrombocytopenia (VITT) associated with ALI. All were admitted with severe COVID-19 and most (80%) developed ALI during hospitalization (median of seven days from admission). The median duration between COVID-19 and ALI symptom onset was 14.5 days (IQR, 11-15). The majority (60%) were taking therapeutic anticoagulation at the time of ALI onset which is the standard of care for patients with severe disease. Five (50%) were successfully revascularized (median time of 3.5 days) and the rest underwent amputation. All survived and were discharged improved.
ALI can occur in the context of COVID-19 even while a patient is on therapeutic dose anticoagulation and in the absence of traditional risk factors. It is wise to be vigilant of this complication for timely intervention and better treatment outcomes.
高凝状态是新型冠状病毒肺炎（COVID-19）感染中常见的并发症。然而，诸如急性肢体缺血（ALI）等动脉血栓形成则较为少见。关于COVID-19患者动脉血栓栓塞并发症的发生率及性质的数据有限，仅来自少数病例报告和病例系列。非洲大陆的数据非常匮乏。
这是一个病例系列，包含10例在埃塞俄比亚亚的斯亚贝巴的埃卡·科特贝综合医院接受治疗时发生ALI的COVID-19患者。对2021年2月1日至2021年12月31日期间收治的所有ALI合并COVID-19患者进行回顾性识别和分析。COVID-19通过逆转录聚合酶链反应（RT-PCR）确诊，ALI在临床怀疑的情况下通过多普勒超声和/或计算机断层血管造影确诊。
在研究期间，共有3098例确诊COVID-19的患者住院。在这一系列10例患者中，包括8例（80%）男性，中位年龄为53.5岁。除1例（10%）外，所有患者都有一个或多个ALI的危险因素，1例有与ALI相关的“可能”的疫苗诱导的血栓性血小板减少症（VITT）病例。所有患者均因重症COVID-19入院，大多数（80%）在住院期间（入院后中位7天）发生ALI。COVID-19症状发作与ALI症状发作之间的中位持续时间为14.5天（四分位间距，11 - 15天）。大多数（60%）患者在ALI发作时正在接受治疗性抗凝，这是重症患者的标准治疗。5例（50%）成功实现血管再通（中位时间为3.5天），其余患者接受了截肢手术。所有患者均存活并出院时病情好转。
即使患者正在接受治疗剂量的抗凝治疗且不存在传统危险因素，COVID-19患者仍可能发生ALI。警惕这种并发症以便及时干预并获得更好的治疗效果是明智的。
