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  1. Article: Massive Pulmonary Embolism and Deep Vein Thrombosis in COVID-19 Pneumonia: Two Case Reports.

    Chopra, Siddharth / Kaur, Jasmeet / Kaur, Mehrvaan

    Cureus

    2021  Volume 13, Issue 5, Page(s) e14833

    Abstract: ... debatable. Here we discuss two cases of COVID-19, who initially presented with mild COVID-19 symptoms and ... old gentleman with a history of sarcoidosis and a recent diagnosis of COVID-19 pneumonia who was ... sleep apnea, and a recent diagnosis of COVID-19 pneumonia, which was complicated with an ischemic stroke ...

    Abstract Coronavirus disease 2019 (COVID-19) is known to cause a severe acute respiratory syndrome with increased morbidity and mortality due to multiorgan involvement. COVID-19 is associated with an increased risk of venous thromboembolism (VTE), ranging from asymptomatic to potentially fatal presentations. Predictors of VTE in COVID-19 are not fully defined, and the role of anticoagulation in these patients is debatable. Here we discuss two cases of COVID-19, who initially presented with mild COVID-19 symptoms and later with potentially fatal VTE within 30 days of initial presentation. The first case is of a 42-year-old gentleman with a history of sarcoidosis and a recent diagnosis of COVID-19 pneumonia who was in isolation at home and presented with syncope and worsening shortness of breath. He was hemodynamically unstable and resuscitated with fluid management in the emergency department. The chest angiogram imaging studies showed massive pulmonary embolism with right heart strain, which was confirmed with bedside point-of-care ultrasound. The patient deteriorated clinically and received an intravenous tissue plasminogen activator in the emergency. He was discharged home under stable condition on oral anticoagulation. The second patient is a 63-year-old gentleman with chronic obstructive pulmonary disease, obesity, sleep apnea, and a recent diagnosis of COVID-19 pneumonia, which was complicated with an ischemic stroke, who presented with worsening complaints of shortness of breath and palpitation. The chest angiogram imaging showed bilateral pulmonary embolism. An echocardiogram showed mild right heart strain. The lower extremity duplex ultrasound showed bilateral deep vein thrombosis. The patient underwent catheter-directed thrombolysis and discharged on oral anticoagulation. There is a need to develop stronger predictors to provide thromboprophylaxis in COVID-19 pneumonia to prevent life-threatening VTE.
    Language English
    Publishing date 2021-05-04
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.14833
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Thrombolysis and use of argatroban for the treatment of massive pulmonary embolism following anticoagulation failure in a patient with COVID-19.

    Sagardia, Lisa M / Daniels, Lisa M

    American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists

    2020  Volume 77, Issue 23, Page(s) 1961–1964

    Abstract: ... Summary: This case report describes a 42-year-old male with COVID-19 who developed a massive pulmonary embolism resulting ... 2019 (COVID-19)-associated massive pulmonary embolism with cardiac arrest is reported ... This is the first case report of use of argatroban in a patient with COVID-19 with cardiac arrest ...

    Abstract Purpose: Successful use of alteplase and argatroban to treat a patient with coronavirus disease 2019 (COVID-19)-associated massive pulmonary embolism with cardiac arrest is reported.
    Summary: This case report describes a 42-year-old male with COVID-19 who developed a massive pulmonary embolism resulting in cardiac arrest after suspected failure of low-molecular-weight heparin therapy for a deep venous thrombosis. Administration of two 50-mg doses of intravenous alteplase resulted in return of spontaneous circulation, and low-dose argatroban was used as follow-up anticoagulation therapy without complications. This is the first case report of use of argatroban in a patient with COVID-19 with cardiac arrest-associated massive pulmonary embolism after failure of previous anticoagulation efforts.
    Conclusion: Argatroban may be used as an alternate anticoagulation strategy in COVID-19 patients who fail low-molecular weight therapy. A risk versus benefit discussion should be had regarding appropriateness of therapy as well as dosing. More data is needed to understand the unique hypercoagulable condition in COVID-19 patients as well as research that further highlights the role of argatroban and bivalirudin therapy in this patient population.
    MeSH term(s) Adult ; Anticoagulants/therapeutic use ; Arginine/analogs & derivatives ; COVID-19 ; Coronavirus Infections/complications ; Fibrinolytic Agents/therapeutic use ; Heart Arrest/etiology ; Heart Arrest/therapy ; Heparin, Low-Molecular-Weight/therapeutic use ; Humans ; Male ; Pandemics ; Pipecolic Acids/therapeutic use ; Pneumonia, Viral/complications ; Pulmonary Embolism/drug therapy ; Pulmonary Embolism/etiology ; Sulfonamides ; Thrombolytic Therapy/methods ; Treatment Failure ; Treatment Outcome
    Chemical Substances Anticoagulants ; Fibrinolytic Agents ; Heparin, Low-Molecular-Weight ; Pipecolic Acids ; Sulfonamides ; Arginine (94ZLA3W45F) ; argatroban (IY90U61Z3S)
    Keywords covid19
    Language English
    Publishing date 2020-09-17
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 1224627-x
    ISSN 1535-2900 ; 1079-2082
    ISSN (online) 1535-2900
    ISSN 1079-2082
    DOI 10.1093/ajhp/zxaa287
    Database MEDical Literature Analysis and Retrieval System OnLINE

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