Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.210022
Jornal Vascular Brasileiro
Therapeutic Challenge

Acute arterial ischemia in COVID-19

Isquemia arterial aguda em pacientes com COVID-19

Silvia Maqueda Ara; Marta Ballesteros Pomar; Nuria Sanz Pastor; Cristina Nogal Arias; Marcos Del Barrio Fernández

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Abstract

Abstract: Since the coronavirus pandemic set in in Spain in March 2020, a noteworthy increase in the incidence of acute limb ischemia (ALI) has been observed. It has been recently discovered that SARS-CoV 2 may lead to ALI secondary to arterial thrombosis. Elevation of D-dimer (DD) in patients with coronavirus infection (COVID-19) indicates that a hypercoagulable state causes acute arterial thrombosis. A remarkably high DD elevation has been reported to be a poor prognosis factor in COVID-19. The ways in which SARS-CoV 2 results in arterial thrombosis may be multiple. On the other hand, surgical revascularization for ALI is associated with poor outcomes in COVID-19 patients, probably in relation to hypercoagulability. Here, we describe two ALI cases in patients who required urgent surgical treatment for limb salvage and were positive for the novel coronavirus infection (COVID 19).

Keywords

COVID-19, ischemia, thrombosis

Resumo

Resumo: Desde que a pandemia pelo novo coronavírus se estabeleceu na Espanha, em março de 2020, um aumento notável da incidência de isquemia aguda de membros foi observado. Recentemente, descobriu-se que o coronavírus 2 causador da síndrome respiratória aguda grave (SARS-CoV-2) pode ocasionar isquemia aguda de membros secundária à trombose arterial. A elevação do D-dímero em pacientes acometidos pela doença do novo coronavírus (COVID-19) indica o estado de hipercoagulabilidade como causa da trombose arterial aguda. Vale destacar que a alta elevação do D-dímero foi relatada como um fator de prognóstico reservado na COVID-19. Há diversas maneiras pelas quais o SARS-CoV-2 pode resultar em trombose arterial. Em pacientes com COVID-19, a revascularização cirúrgica para isquemia aguda de membros está associada a desfechos desfavoráveis, provavelmente relacionados a hipercoagulabilidade. Descrevemos dois casos de isquemia aguda de membros de pacientes que necessitaram de tratamento cirúrgico de urgência para salvamento de membro e que haviam testado positivo para COVID-19.
 

Palavras-chave

COVID-19, isquemia, trombose

References

1 World Health Organization. Coronavirus disease (COVID-19) situation dashboard. 2020 [cited 2020 may 5]. https://www.who.int/emergencies/diseases/novel-coronavirus-2019

2 Zhang L, Yan X, Fan Q, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost. 2020;18(6):1324-9. http://dx.doi.org/10.1111/jth.14859. PMid:32306492.

3 Arachchillage DR, Laffan M. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(5):1233-4. http://dx.doi.org/10.1111/jth.14820. PMid:32291954.

4 Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-7. http://dx.doi.org/10.1111/jth.14768. PMid:32073213.

5 Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18(5):1023-6. http://dx.doi.org/10.1111/jth.14810. PMid:32338827.

6 Wong JP, Viswanathan S, Wang M, Sun LQ, Clark GC, D’Elia RV. Current and future developments in the treatment of virus-induced hypercytokinemia. Future Med Chem. 2017;9(2):169-78. http://dx.doi.org/10.4155/fmc-2016-0181. PMid:28128003.
 


Submitted date:
01/28/2021

Accepted date:
03/13/2021

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