key: cord-0814721-q80a40uu
authors: Shah, Kushang
title: SARS-CoV-2 and Thrombosis: More Than Just by Chance
date: 2020-07-17
journal: Am J Med Sci
DOI: 10.1016/j.amjms.2020.07.023
sha: f7b2bc1a51982dc2653576fb38a4e925efcfc597
doc_id: 814721
cord_uid: q80a40uu

nan

Key terms: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); pulmonary embolism; thrombosis; d-dimer Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global stir to health-systems and families. As of July 2020, SARS-CoV-2 has infected 13.4 million people and resulted in 580,552 deaths. 1 Recent literature has shown patients with SARS-CoV-2 are at risk for a host of devastating diseases such as acute respiratory distress syndrome, strokes, myocarditis, and venous thromboembolism. Here is a case of a patient diagnosed with SARS-CoV-2 presenting with pulmonary embolism.

A 68-year-old male presents to the Emergency Department, ED, with exertional shortness of breath, and fevers. He was diagnosed with SARS-CoV-2 ten days prior to presentation. At home he reported frequent episodes of fever with the highest reading of 103 °F and his pulse oximeter showed oxygen saturation above 95%. On the day of his presentation, he developed exertional shortness of breath and his home pulse oximeter showed an oxygen level of 78%. When he reported to the ED, he was afebrile, heart rate was 111 bpm, respiratory rate was 18 breaths per minute, blood pressure was 143/79 mmHg, and oxygen saturation was 80% on room air. He was placed on a non-rebreather mask and maintained an oxygen saturation of 95%. His laboratory markers were significant for a D-dimer of 41,385 ng/mL, Ntpro-BNP 267 pg/mL, and troponin-T was ≤ 0.01 ng/mL. EKG showed sinus tachycardia of 105 bpm. Chest x-ray showed hazy and patchy airspace opacities bilaterally.

Given the acute onset of shortness of breath, hypoxia, and a very high d-dimer level, a CT Chest Pulmonary Angiography with IV Contrast (CTA) was ordered. A filling defect was seen in the left lower lobe subsegmental pulmonary arterial tree, with multiple additional filling defects visible in both lungs consistent with pulmonary emboli. Diffuse ground-glass and consolidative 3 airspace opacities were seen in both lung fields consistent with SARS-CoV-2 infection (Fig. 1, Fig.   2 ). Patient was started on therapeutic anticoagulation with heparin. After 5 days, the patient's hemoglobin oxygen saturation was 94% on room air, D-dimer was 2800 ng/mL, and he was discharged home with apixaban. showed patients with sepsis-induced coagulopathy score ≥ 4, or D-dimer >6-fold of upper limit of normal had a statistically significant reduced 28-day mortality when treated with mainly low molecular weight heparin compared to no heparin treatment. 5 Furthermore, a retrospective analysis in a New York City hospital system, showed treatment dose systemic anticoagulation (AC) in mechanically ventilated patients had a mortality rate of 29.1% as compared to 62.7% without AC. 6 Hospitals have adopted protocols for administration of higher prophylactic doses 

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