Unusual arterial thrombotic events in Covid-19 patients

Abstract

Introduction: COVID-19 infection is commonly complicated with pro-thrombotic state and endothelial dysfunction. While several studies reported a high incidence of venous thromboembolic events. The occurrence of arterial thromboses are yet rarely described and could be underestimated.

Objectives: To describe the clinical and biological characteristics of COVID-19 patients presenting with an associated arterial thromboembolic event.

Material and methods: We performed a retrospective multicentric study in 3 centers between France and Italy. All patients with a confirmed SARS-CoV-2 infection and arterial thromboembolic events were included in the analysis.

Results: From March 8th to April 25th 2020, we identified 20 patients (24 events) with arterial thromboembolic events over 209 admitted patients (9.6%) with severe COVID-19 infection. Arterial thrombotic events included acute coronary occlusions (n = 9), stroke (n = 6), limb ischemia (n = 3), splenic infarcts (n = 3), aortic thrombosis (n = 2) and occlusive mesenteric ischemia (n = 1). At the time of the event, 10/20 (50%) of patients received thromboprohylaxis, 2/20 (10%) were receiving treatment dose anticoagulation and 5/20 (25%) were receiving antiplatelet therapy.

Conclusion: Our observations suggest that serious arterial thrombotic events might occur in Covid-19 patients. However, the exact incidence of such events and the best way to prevent them yet remains to be investigated.

Keywords: Acute coronary syndrom; Anticoagulation; Arterial thrombosis; Covid-19; SARS-CoV-2.

Fig. 1

Fatal aortic thrombosis in COVID-19 patient. Arterial-TDM showing extended intra-luminal aortic thrombi in a patient suffering from COVID-19. A 74 years old patient was admitted in ICU for respiratory failure. Nasal swab confirmed the suspected COVID-19. Doppler ultrasound revealed no deep venous thrombosis despite D-dimers >20000UI/L. The patient received prophylactic enoxaparin (4000UI/12 h). On the 6th day, the patient presented lower limb ischemia and abdominal occlusion syndrome. Subsequent Arterial-TDM revealed de novo multifocal and circumferential aortic thrombi of suprarenal and subrenal localization, with up to 50% occlusion on the infra-renal portion. There were no associated deep vein thrombosis nor pulmonary embolism.