key: cord-0756471-0qbnrlk3 authors: Gold, Daniel D.; Kurd, Ramzi; Einav, Sharon title: Don't forget arterial thrombosis in patients with COVID-19: A case series date: 2021-08-04 journal: Thrombosis Update DOI: 10.1016/j.tru.2021.100065 sha: 61c612fb15917f0be7136c851664a853cc6e72d9 doc_id: 756471 cord_uid: 0qbnrlk3 Introduction The acute disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS COV-2) is accompanied by a hypercoagulable state. Multiple publications have described the venous thromboembolic events associated with coronavirus disease 2019 (COVID-19) but arterial thromboembolic events have yet to be described. Cases description We describe five COVID-19 patients that developed severe morbidity as a result of occlusive arterial thromboembolic events occurring despite treatment with low molecular weight heparin. All cases presented with an acute confusional state and were accompanied by rapid elevations of lactate and D-dimers and leukocytes. The end organs involved were the kidneys, spleen, liver, lungs, central nervous system, intestines and limbs. Only one of the five patients survived. Conclusion COVID-19 is associated with not only venous but also arterial thromboembolic events. Further research is required to clarify the incidence, causes and possible modes of prevention of this potentially lethal disease complication. Cases description: We describe five COVID-19 patients that developed severe morbidity as a 47 result of occlusive arterial thromboembolic events occurring despite treatment with low 48 molecular weight heparin. All cases presented with an acute confusional state and were 49 accompanied by rapid elevations of lactate and D-dimers and leukocytes. The end organs 50 involved were the kidneys, spleen, liver, lungs, central nervous system, intestines and limbs. 51 Only one of the five patients survived. 52 Conclusion: COVID-19 is associated with not only venous but also arterial thromboembolic 53 events. Further research is required to clarify the incidence, causes and possible modes of 54 prevention of this potentially lethal disease complication. The hypercoagulable condition accompanying COVID-19 patients has been reported 60 extensively and is associated with high morbidity and mortality [1, 2] Thromboinflammation and the hypercoagulability of COVID-19 High 168 risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter 169 prospective cohort study Higher 172 anticoagulation targets and risk of thrombotic events in severe COVID-19 patients: bi-173 center cohort study Thrombotic 176 complications in 2928 patients with COVID-19 treated in intensive care: a systematic 177 review 180 Confirmation of the high cumulative incidence of thrombotic complications in 181 critically ill ICU patients with COVID-19: An updated analysis SARS-2 Coronavirus-Associated Hemostatic Lung Abnormality 184 in COVID-19: Is It Pulmonary Thrombosis or Pulmonary Embolism? Semin Thromb 185 Registry of 187 Arterial and Venous Thromboembolic Complications in Patients With COVID-19 Pulmonary 190 and cardiac pathology in African American patients with COVID-19: an autopsy series 191 from New Orleans Acute 194 mesenteric thrombosis in two patients with COVID-19. Two cases report and 195 literature review Zinovkin 198 RA. COVID-19 and Oxidative Stress Coronavirus 201 disease-19: The multi-level, multi-faceted vasculopathy The 204 procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome Profile of natural anticoagulant, 207 coagulant factor and anti-phospholipid antibody in critically ill COVID-19 patients The 210 distinctive structure and composition of arterial and venous thrombi and pulmonary 211 emboli Platelets Can Associate 213 with SARS-CoV-2 RNA and Are Hyperactivated in COVID-19 Platelet activation and platelet-monocyte aggregate formation trigger tissue factor 217 expression in patients with severe COVID-19 ☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.☐The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:All authors declare no known conflict of interest J o u r n a l P r e -p r o o f