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      A Unique Case of COVID-19-related Acute Coronary Thrombosis Complicated by Severe Hypokalemia

      case-report
      Author(s): , MC, USA, , MC, USA, , MC, USA
      Publication date (Electronic):
      Journal: Military Medicine
      Publisher: Oxford University Press

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          ABSTRACT

          We report the case of a 52-year-old white male who was recently diagnosed with symptomatic coronavirus disease-2019 (COVID-19) and presented to the hospital with ventricular tachycardia/ventricular fibrillation cardiac arrest, ST elevation myocardial infarction, and profound hypokalemia. The patient was successfully treated with primary percutaneous coronary intervention and concurrent aggressive potassium repletion. To the authors’ knowledge, this is the first case of COVID-19 presenting not only with an acute coronary thrombosis but also severe hypokalemia, both of which contributed to his cardiac arrest. The association of COVID-19 with acute coronary thrombosis, including the challenges surrounding the diagnosis and management in this patient population, is discussed. Additionally, the effect of COVID-19 on the renin–angiotensin–aldosterone system is reviewed with a focus on hypokalemic presentations.

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          Incidence of thrombotic complications in critically ill ICU patients with COVID-19

          F.A. Klok, M.J.H.A. Kruip, N.J.M. van der Meer … (2020)
          Introduction COVID-19 may predispose to both venous and arterial thromboembolism due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation. Reports on the incidence of thrombotic complications are however not available. Methods We evaluated the incidence of the composite outcome of symptomatic acute pulmonary embolism (PE), deep-vein thrombosis, ischemic stroke, myocardial infarction or systemic arterial embolism in all COVID-19 patients admitted to the ICU of 2 Dutch university hospitals and 1 Dutch teaching hospital. Results We studied 184 ICU patients with proven COVID-19 pneumonia of whom 23 died (13%), 22 were discharged alive (12%) and 139 (76%) were still on the ICU on April 5th 2020. All patients received at least standard doses thromboprophylaxis. The cumulative incidence of the composite outcome was 31% (95%CI 20-41), of which CTPA and/or ultrasonography confirmed VTE in 27% (95%CI 17-37%) and arterial thrombotic events in 3.7% (95%CI 0-8.2%). PE was the most frequent thrombotic complication (n = 25, 81%). Age (adjusted hazard ratio (aHR) 1.05/per year, 95%CI 1.004-1.01) and coagulopathy, defined as spontaneous prolongation of the prothrombin time > 3 s or activated partial thromboplastin time > 5 s (aHR 4.1, 95%CI 1.9-9.1), were independent predictors of thrombotic complications. Conclusion The 31% incidence of thrombotic complications in ICU patients with COVID-19 infections is remarkably high. Our findings reinforce the recommendation to strictly apply pharmacological thrombosis prophylaxis in all COVID-19 patients admitted to the ICU, and are strongly suggestive of increasing the prophylaxis towards high-prophylactic doses, even in the absence of randomized evidence.
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            COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up

            Behnood Bikdeli, Mahesh Madhavan, David Jiménez … (2020)
            Coronavirus disease 2019 (COVID-19), a viral respiratory illness caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may predispose patients to thrombotic disease, both in the venous and arterial circulations, due to excessive inflammation, platelet activation, endothelial dysfunction, and stasis. In addition, many patients receiving antithrombotic therapy for thrombotic disease may develop COVID-19, which can have implications for choice, dosing, and laboratory monitoring of antithrombotic therapy. Moreover, during a time with much focus on COVID-19, it is critical to consider how to optimize the available technology to care for patients without COVID-19 who have thrombotic disease. Herein, we review the current understanding of the pathogenesis, epidemiology, management and outcomes of patients with COVID-19 who develop venous or arterial thrombosis, and of those with preexisting thrombotic disease who develop COVID-19, or those who need prevention or care for their thrombotic disease during the COVID-19 pandemic.
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              High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study

              Julie Helms, Charles Tacquard, François Séverac … (2020)
              Little evidence of increased thrombotic risk is available in COVID-19 patients. Our purpose was to assess thrombotic risk in severe forms of SARS-CoV-2 infection.
              Article 0 comments Cited 1430 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                CPT Matthew Lavoie
                CPT Ariana Ramirez:
                ORCID: https://orcid.org/0000-0002-5813-1041
                COL Jeffrey Kunz
                Journal
                Journal ID (nlm-ta): Mil Med
                Journal ID (iso-abbrev): Mil Med
                Journal ID (publisher-id): milmed
                Title: Military Medicine
                Publisher: Oxford University Press (US )
                ISSN (Print): 0026-4075
                ISSN (Electronic): 1930-613X
                Publication date (Electronic): 16 March 2021
                Electronic Location Identifier: usab100
                Affiliations
                departmentDepartment of Internal Medicine, Madigan Army Medical Center , Joint Base Lewis-McChord, WA 98431, USA
                departmentDepartment of Internal Medicine, Madigan Army Medical Center , Joint Base Lewis-McChord, WA 98431, USA
                departmentDepartment of Internal Medicine, Madigan Army Medical Center , Joint Base Lewis-McChord, WA 98431, USA
                Author notes
                The views expressed are solely those of the authors and do not reflect the official policy or position of the U.S. Army, U.S. Navy, U.S. Air Force, the Department of Defense, or the U.S. government.
                Author information
                https://orcid.org/0000-0002-5813-1041
                Article
                Publisher ID: usab100
                DOI: 10.1093/milmed/usab100
                PMC ID: 7989398
                PubMed ID: 33724426
                SO-VID: 20d2b972-5b61-4420-bc3b-d65ca80bae04
                Copyright © Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.
                License:

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                This work is written by (a) US Government employee(s) and is in the public domain in the US.

                History
                Date received : 12 December 2020
                Date revision received : 03 February 2021
                Date accepted : 03 March 2021
                Date: 02 March 2021
                Page count
                Pages: 5
                Funding
                Funded by: Madigan Army Medical Center, DOI 10.13039/100010193;
                Award ID: 81770567
                Categories
                Subject: Case Report
                Subject: AcademicSubjects/MED00010
                Custom metadata
                article-lifecycle PAP

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