Περίληψη:
Objective: Background: Case Report: Conclusions: Educational purpose Recent studies demonstrated evidence of coagulation dysfunction in hospitalized patients with severe coronavirus disease 2019 (COVID-19) due to excessive inflammation, hypoxia, platelet activation, endothelial dysfunction, and stasis. Effective anticoagulation therapy may play a dominant role in the management of severe COVID-19 cases. A 73-year-old man with a 6-day history of fever up to 38.5°C, dyspnea, cough, and fatigue was diagnosed with COVID-19. He had a past medical history significant for hypertension and coronary artery bypass grafting. Two days after hospital admission, the patient developed acute respiratory failure, requiring intubation, mechanical ventilation, and transfer to the intensive care unit (ICU). He received treatment including antibiotics, hydroxychloroquine, tocilizumab, vasopressors, prone positioning, and anticoagulation with enoxaparin at a prophylactic dose. After a 15-day ICU stay, the patient was hemodynamically stable but still hypoxemic; a transthoracic echocardiogram at that time, followed by a transesophageal echocardiogram for better evaluation, revealed the presence of a right atrium thrombus without signs of acute right ventricular dilatation and impaired systolic function. Since the patient was hemodynamically stable, we decided to treat him with conventional anticoagulation under close monitoring for signs of hemodynamic deterioration; thus, the prophylactic dose of enoxaparin was replaced by therapeutic dosing, which was a key component of the patient’s successful outcome. Over the next few days he showed significant clinical improvement. The follow-up transesophageal echocardiogram 3 weeks after effective therapeutic anticoagulation revealed no signs of right heart thrombus. The presented COVID-19 case, one of the first reported cases with evidence of right heart thrombus by transesophageal echocardiography, highlights the central role of diagnostic imaging strategies and the importance of adequate anticoagulation therapy in the management of severe COVID-19 cases in the ICU. © Am J Case Rep, 2020.
Συγγραφείς:
Anthi, A.
Konstantonis, D.
Theodorakopoulou, M.
Apostolopoulou, O.
Karampela, I.
Konstantopoulou, G.
Patsilinakou, S.
Armaganidis, A.
Dimopoulos, G.
Λέξεις-κλειδιά:
azithromycin; C reactive protein; enoxaparin; ferritin; hydroxychloroquine; procalcitonin; sultamicillin, aged; Article; artificial ventilation; blood clot lysis; case report; clinical article; computer assisted tomography; coronavirus disease 2019; coughing; differential diagnosis; disease severity; dyspnea; fatigue; ferritin blood level; fever; heart hemodynamics; hospital discharge; human; intensive care unit; leukocyte count; lung embolism; male; nose smear; physical examination; protein blood level; real time polymerase chain reaction; throat culture; thromboembolism; thrombus; transesophageal echocardiography; complication; Coronavirus infection; coughing; diagnostic imaging; disease exacerbation; fever; follow up; Greece; heart atrium; heart disease; hospital emergency service; intensive care; length of stay; multimodality cancer therapy; pandemic; pathology; procedures; severe acute respiratory syndrome; severity of illness index; thrombosis; treatment outcome; virus pneumonia, Aged; Combined Modality Therapy; Coronavirus Infections; Cough; Critical Care; Disease Progression; Echocardiography, Transesophageal; Emergency Service, Hospital; Fever; Follow-Up Studies; Greece; Heart Atria; Heart Diseases; Humans; Intensive Care Units; Length of Stay; Male; Pandemics; Pneumonia, Viral; Severe Acute Respiratory Syndrome; Severity of Illness Index; Thrombosis; Treatment Outcome
