一名感染新冠肺炎19后接受抗凝治疗的患者并发急性下肢动脉和深静脉血栓形成。

IF 0.1 4区 医学 Q4 MEDICINE, RESEARCH & EXPERIMENTAL Investigacion clinica Pub Date : 2022-05-31 DOI:10.54817/ic.v63n2a06
Ersin Çelik, Ahmet Rıfkı Çora
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引用次数: 0

摘要

在2019冠状病毒感染后,高凝状态继续存在,建议在此期间使用预防性抗凝药物。然而,在Covid - 19后的恢复期可以观察到动脉和静脉血栓栓塞事件。在这里,我们报告了一例77岁的患者在covid - 19后发生的急性下肢动脉和静脉血栓栓塞,接受治疗剂量的抗凝治疗(每12小时服用1mg/kg体重的依诺哌林)。患者既往无动脉或静脉血栓形成史,因急性动脉血栓形成而被诊断为急性肢体缺血,接受急诊手术治疗。在局部麻醉下,在左股动脉插入4F Fogarty导管的帮助下进行动脉血栓切除术。术后患者远端脉搏均可触及。待血小板计数达到100万mm3后,在依诺肝素钠治疗剂量的基础上每日加入乙酰水杨酸100 mg。患者顺利出院,术后第5天,在依诺肝素和乙酰水杨酸联合治疗下,继发于深静脉血栓(DVT)的微小直径增加。在covid - 19后恢复期,内皮损伤、慢性免疫性血栓形成性和血小板聚集性增加可导致重大血栓事件,甚至在恢复后数周。当存在以下情况时,建议抗凝治疗用于血栓预防:≥65岁、危重疾病、癌症、既往静脉血栓栓塞、血栓形成、严重不活动和Ddimer升高。在抗凝治疗下发生血栓栓塞事件时,联合长期抗凝治疗可能是谨慎的。
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Concomitant acute lower extremity arterial and deep vein thrombosis developing in a patient under anticoagulant therapy after COVID 19 infection.
The hypercoagulable state continues after the Coronavirus 2019 (Covid 19) infection and prophylactic anticoagulants are recommended in this period. However, arterial and venous thromboembolic events can be observed during the convalescence period after the Covid 19. Here, we present the case of acute lower extremity arterial and venous thromboembolism developed in the post-Covid 19 period in a 77-years-old patient, under therapeutic doses of anticoagulant therapy (enoxparin 1mg/kg of weight every 12 hours). The patient, who had no previous history of arterial or venous thrombosis, was taken to emergency surgery with the diagnosis of ALI (acute limb ischemia) due to acute arterial thrombosis. An arterial thrombectomy was performed with the help of a 4F Fogarty catheter inserted from the left femoral artery under local anesthesia. All distal pulses of the patient were palpable in the postoperative period. After the platelet count became >100,000 mm3, 100 mg of acetylsalicylic acid daily was added to the therapeutic dose of enoxaparin sodium treatment. The patient was discharged, uneventfully, except for a minimal diameter increase secondary to deep venous thrombosis (DVT) on the fifth postoperative day, with a combination of enoxaparin and acetylsalicylic acid treatment. Endothelial injury, chronic immuno-thrombogenicity, and increased platelet aggregation in the post-Covid 19 recovery period can cause major thrombotic events, even weeks after the recovery. Anticoagulant therapy is recommended for thromboprophylaxis when the following statuses exist: ≥65 years, critical illness, cancer, prior VTE, thrombophilia, severe immobility, and elevated Ddimer. Combination treatment with long-term antiaggregant therapy may be prudent in thromboembolic events developed under anticoagulant therapy.
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来源期刊
Investigacion clinica
Investigacion clinica MEDICINE, RESEARCH & EXPERIMENTAL-
CiteScore
0.20
自引率
50.00%
发文量
2
审稿时长
>12 weeks
期刊介绍: Estudios humanos, animales y de laboratorio relacionados con la investigación clínica y asuntos conexos.
期刊最新文献
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