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      Fibrinolytic Administration via EkoSonic™ Endovascular System (EKOS) Catheter Used in Acute Aortic Occlusion Secondary to COVID-19

      case-report
      Author(s): 1 , 2 , , 3
      Editor(s): ,
      Publication date (Electronic, pub):
      Publication date (Electronic, collection):
      Journal: Cureus
      Publisher: Cureus
      Keywords: covid-19, acute aortic occlusion, fibrinolytics, ekos catheter, thrombosis

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          Abstract

          Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19 is the virus responsible for the 2019 global pandemic. Pulmonary complications of COVID-19 are well established in the literature. However, the virus causes numerous extrapulmonary manifestations, notably acute aortic occlusion (AAO). COVID-19 creates a hypercoagulable state via the upregulation of numerous procoagulant cytokines in endothelial cells of blood vessels. We present a case of a 63-year-old patient without a previous history of prothrombotic disorders who developed AAO in the distal abdominal aorta and bilateral common iliac arteries after contracting COVID-19. The patient was a poor surgical candidate and was treated with fibrinolytics that were administered via an EkoSonic™ Endovascular System (EKOS) catheter using a bilateral transfemoral approach. This case highlights a unique treatment option for non-surgical candidates with AAO.

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          Potential Effects of Coronaviruses on the Cardiovascular System: A Review

          Mohammad Madjid, Payam Safavi-Naeini, Scott Solomon … (2020)
          Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19) has reached a pandemic level. Coronaviruses are known to affect the cardiovascular system. We review the basics of coronaviruses, with a focus on COVID-19, along with their effects on the cardiovascular system.
          Article 0 comments Cited 934 times – based on 0 reviews     Review now
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            In vitro hypercoagulability and ongoing in vivo activation of coagulation and fibrinolysis in COVID‐19 patients on anticoagulation

            Annabel Blasi, Fien A. von Meijenfeldt, Jelle Adelmeijer … (2020)
            Abstract Background COVID‐19 is associated with a substantial risk of venous thrombotic events, even in the presence of adequate thromboprophylactic therapy. Objectives We aimed to better characterize the hypercoagulable state of COVID‐19 patients in patients receiving anticoagulant therapy. Methods We took plasma samples of 23 patients with COVID‐19 who were on prophylactic or intensified anticoagulant therapy. Twenty healthy volunteers were included to establish reference ranges. Results COVID‐19 patients had a mildly prolonged prothrombin time, high VWF levels and low ADAMTS13 activity. Most rotational thromboelastometry parameters were normal, with a hypercoagulable maximum clot firmness in part of the patients. Despite detectable anti‐Xa activity in the majority of patients, ex vivo thrombin generation was normal, and in vivo thrombin generation elevated as evidenced by elevated levels of thrombin‐antithrombin complexes and D‐dimers. Plasma levels of activated factor VII were lower in patients, and levels of the platelet activation marker soluble CD40 ligand were similar in patients and controls. Plasmin‐antiplasmin complex levels were also increased in patients despite an in vitro hypofibrinolytic profile. Conclusions COVID‐19 patients are characterized by normal in vitro thrombin generation and enhanced clot formation and decreased fibrinolytic potential despite the presence of heparin in the sample. Anticoagulated COVID‐19 patients have persistent in vivo activation of coagulation and fibrinolysis, but no evidence of excessive platelet activation. Ongoing activation of coagulation despite normal to intensified anticoagulant therapy indicates studies on alternative antithrombotic strategies are urgently required.
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              Aortic thrombus in patients with severe COVID-19: review of three cases

              María de Carranza, Danilo-Eduardo Salazar, Jesús Troya … (2020)
              Coronavirus disease 2019 (COVID-19) could predispose to both venous and arterial thromboembolism, in an exaggerated immune response to the virus, especially in severe patients. Even though aortic clots are a rare entity, the pro-coagulant nature of COVID-19 is associated with thrombosis in atypical locations and should be considered in patients with severe abnormalities in coagulation parameters. We describe a series of three cases of aortic thrombi diagnosed by computerized tomography (CT) angiography in patients with confirmed SARS-CoV-2 infection.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 4 August 2021
                Publication date (Electronic, collection): August 2021
                Volume: 13
                Issue: 8
                Electronic Location Identifier: e16893
                Affiliations
                [1 ] Internal Medicine, Detroit Medical Center, Detroit, USA
                [2 ] Emergency Medicine, Detroit Medical Center, Detroit, USA
                [3 ] Interventional Radiology, Detroit Medical Center, Detroit, USA
                Author notes
                Jordan Richardson richa880@ 123456msu.edu
                Article
                DOI: 10.7759/cureus.16893
                PMC ID: 8417098
                PubMed ID: 34513466
                SO-VID: d3941676-726d-4bad-9ea9-84047e7f183c
                Copyright © Copyright © 2021, Moynihan et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 4 August 2021
                Categories
                Subject: Cardiac/Thoracic/Vascular Surgery
                Subject: Radiology
                Subject: Hematology

                Keywords: covid-19,acute aortic occlusion,fibrinolytics,ekos catheter,thrombosis
                Data availability:
                Keywords: covid-19, acute aortic occlusion, fibrinolytics, ekos catheter, thrombosis

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