Case Report: The Coronavirus Disease 2019 (COVID-19) Pneumonia With Multiple Thromboembolism

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out in Wuhan, China, in late December 2019 and has since spread rapidly around the world. Severe coronavirus disease 2019 (COVID-19) pneumonia patients have abnormal blood coagulation function, but their thromboembolism prevalence is still unknown. We reported a case of a 49-year-old man infected with COVID-19, presenting with fever, chest pain, limb weakness, myalgia, and dyspnea. The patient was diagnosed with severe COVID-19 pneumonia, pulmonary thromboembolism (PTE), deep vein thrombosis (DVT), and cerebral infarction. He received supportive and empirical treatment including anticoagulant treatment, anti-inflammatory treatment, oxygen supply, and inhalation therapy. The patient's symptoms, CT images, and laboratory results improved after treatment, and a throat swab was reported to be negative for SARS-CoV-2 virus by polymerase chain reaction (PCR) test. However, on day 51 of illness onset, CT reexamination demonstrated hemorrhagic infarction. Anticoagulant therapy was discontinued temporarily. After the patient tested negative for SARS-CoV-2 virus by PCR test six more times, he was discharged and remained in home quarantine. This case highlights the importance of clinician attentiveness to the appearance of multiple thromboembolism, especially in patients with severe pulmonary damage. It also emphasizes the diagnostic value of early CT imaging and the need for effective treatment once thrombotic events occur.

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D-Dimers, Thrombin Antithrombin III Complexes and Prothrombin Fragments 1 + 2: Diagnostic value in Clinically Suspected Deep Vein Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1647449 ◽

1991 ◽

Vol 65 (01) ◽

pp. 028-032 ◽

Cited By ~ 105

Author(s):

B Boneu ◽

G Bes ◽

H Pelzer ◽

P Sié ◽

H Boccalon

Keyword(s):

Deep Vein Thrombosis ◽

Antithrombin Iii ◽

High Sensitivity ◽

Diagnostic Value ◽

Predictive Values ◽

Vein Thrombosis ◽

High Negative Predictive Value ◽

Deep Vein ◽

D Dimer ◽

Mercury Strain Gauge

SummaryThis study was performed to determine the accuracy of D-Dimer fibrin derivatives, thrombin-antithrombin III (TAT) complexes and prothrombin fragments 1 + 2 (F 1 + 2) determinations for the diagnosis of deep vein thrombosis (DVT). One hundred and sixteen consecutive patients referred to the angiology unit of our hospital for a clinically suspected DVT were investigated. They were submitted to mercury strain gauge plethysmography and to ultrasonic duplex scanning examination; in cases of inconclusive results or of proximal DVT (n = 35), an ascending phlebography was performed. After these investigations were completed, the diagnosis of DVT was confirmed in 34 and excluded in 82. One half of the patients were already under anticoagulant therapy at the time of investigation. The 3 biological markers were assayed using commercially available ELISA techniques and the D-Dimer was also assayed with a fast latex method. The normal distribution of these markers was established in 40 healthy blood donors. The most accurate assay for the diagnosis of DVT was the D-Dimer ELISA which had both a high sensitivity (94%) and a high negative predictive value (95%). The D-Dirner latex, TAT complexes and F 1 + 2 were far less sensitive and provided negative predictive values which ranged between 78 and 85%. In spite of positive and significant correlations between the levels of ihe 3 markers, their association did not improve their overall accuracy for detecting D\/L Therefore, with the exception of the D-Dimer ELISA, these markers were of little value for the diagnosis of DVT in this specific population.

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Performance of five D-dimer assays for the exclusion of symptomatic distal leg vein thrombosis

Thrombosis and Haemostasis ◽

10.1160/th11-07-0511 ◽

2012 ◽

Vol 107 (02) ◽

pp. 369-378 ◽

Cited By ~ 14

Author(s):

Jan Schwonberg ◽

Carola Hecking ◽

Marc Schindewolf ◽

Dimitrios Zgouras ◽

Susanne Lehmeyer ◽

...

Keyword(s):

High Sensitivity ◽

Diagnostic Value ◽

Vein Thrombosis ◽

Clinical Probability ◽

Wells Score ◽

Deep Vein ◽

Test Result ◽

D Dimer ◽

Rule Out ◽

Compression Ultrasonography

SummaryThe diagnostic value of D-dimer (DD) in the exclusion of proximal deep-vein thrombosis (DVT) is well-established but is less well-known in the exclusion of distal (infrapopliteal) DVT. Therefore, we evaluated the diagnostic abilities of five DD assays (Vidas-DD, Liatest-DD, HemosIL-DD, HemosIL-DDHS, Innovance-DD) for excluding symptomatic proximal and distal leg DVT. A total of 243 outpatients whose symptoms were suggestive of DVT received complete compression ultrasonography (cCUS) of the symptomatic leg(s). The clinical probability of DVT (PTP) was assessed by Wells score. Thirty-eight proximal and 31 distal DVTs (17 tibial/fibular DVTs, 14 muscle DVTs) were diagnosed by cCUS. Although all assays showed high sensitivity for proximal DVT (range 97–100%), the sensitivity was poor for distal DVT (range 78–93%). None of the assays were individually able to rule out all DVTs as a stand-alone test (negative predictive value [NPV] 91–96%). However, a negative DD test result combined with a low PTP exhibited a NPV of 100% for all DVTs (including proximal, tibial/fibular, and muscle DVTs) with the HemosIL-DDHS and Innovance-DD. All proximal and tibial/fibular DVTs, but not all muscle DVTs, could be ruled out with this strategy using the Liatest-DD and Vidas-DD. The HemosIL-DD could not exclude distal leg DVT, even in combination with a low PTP. The combination of a negative DD with a low PTP showed a specificity of 32–35% for all DVTs. In conclusion, our study shows that when used in conjunction with a low PTP some DD assays are useful tools for the exclusion of distal leg DVT.

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SPECTRUM OF HRCT CHEST FINDINGS IN COVID-19

10.36106/ijsr/5622153 ◽

2021 ◽

pp. 52-54

Author(s):

Nilesh H Chaudhari ◽

Dhiraj S Pati ◽

Saurabh R Sonawane ◽

Rohit S Raje ◽

Vishal A Gehi ◽

...

Keyword(s):

High Spatial Frequency ◽

Reconstruction Algorithm ◽

Ground Glass ◽

Rt Pcr ◽

High Resolution Computed Tomography ◽

Vein Thrombosis ◽

Diffuse Lung Diseases ◽

Polymerase Chain ◽

Deep Vein ◽

Diffuse Lung

INTRODUCTION: Coronavirus (COVID-19) pandemic is current ongoing pandemic in world since its outbreak in Wuhan China in December 2019. It has affected 78.8 million people with 1.7 million deaths worldwide till date (23rd December 2020). To evaluate spectrum of HRCT AIMS: Chest ndings in patients infected with SARS-CoV-2 i.e. COVID-19. HRCT were done in MATERIAL AND METHODS: 242 patients with SARS-CoV-2 RT-PCR positive status admitted in our COVID CARE CENTRE. HRCT is useful in assessment of severity of COVID-19 infection and subsequent plan for the treatment. HRCT of the chest obtains thin-slice chest images and process in a high-spatial-frequency reconstruction algorithm. This technique obtains images with exquisite lung detail, which are ideal for the assessment of diffuse lung diseases. RESULTS: Ground glass opacication is predominant nding present in majority of cases of COVID-19. Other common ndings include crazy paving pattern, consolidation, vascular dilation and subpleural linear opacities. These ndings can aid in early diagnosis of COVID-19. ABBREVIATIONS: HRCT (High-resolution computed tomography), COVID-19(Coronavirus disease-19), SARS-CoV-2(severe acute respiratory syndrome coronavirus 2), GGO (ground glass opacication), ARDS (acute respiratory distress syndrome), RT-PCR (reverse transcriptase-polymerase chain reaction), DIC (disseminated intravascular coagulation), DVT (deep vein thrombosis).

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Thrombophilic risk factors are laterally associated with Apolipoprotein E gene polymorphisms in deep vein thrombosis patients: An Indian study

Phlebology The Journal of Venous Disease ◽

10.1177/0268355518802693 ◽

2018 ◽

Vol 34 (5) ◽

pp. 324-335

Author(s):

Pulkit Rastogi ◽

Narender Kumar ◽

Jasmina Ahluwalia ◽

Reena Das ◽

Neelam Varma ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Gene Polymorphisms ◽

Apoe Gene ◽

Therapeutic Implications ◽

Vein Thrombosis ◽

Apolipoprotein E Gene ◽

Polymerase Chain ◽

Apoe Genotypes ◽

Deep Vein

Introduction Deep vein thrombosis is a multifactorial disease with many acquired and genetic risk factors. Polymorphism in the APOE gene is an upcoming potential pathogenic factor whose role is unclear in deep vein thrombosis. Methods An equal number of deep vein thrombosis cases and controls (N = 100, each) were investigated for APOE gene polymorphisms along with known acquired and hereditable thrombophilic risk factors. APOE genotyping was done by polymerase chain reaction. Results The ε3/ε4 and ε2/ε3 APOE genotypes were commoner in deep vein thrombosis cases than controls but not statistically significant ( ε3/ε4 → 18% versus 11%, OR = 1.776, CI = 0.792–3.984, p = 0.16; ε2/ε3 →10% versus 9%, OR = 1.123, CI = 0.436–2.895, p = 0.809). However, the following risk factors were found to be laterally associated with APOE genotypes in cases of deep vein thrombosis: pregnancy with ε2/ε3 genotype positivity (N = 29; p = 0.019), recurrent pregnancy loss with ε3/ε3 genotype (N = 29; p = 0.016), normal antithrombin levels with ε3/ε3 genotype (N = 62; p = 0.03) and non-O blood group with ε3/ε4 genotype (N = 100; p = 0.023). Conclusion APOE genotypes have shown only a modest association with deep vein thrombosis and were not statistically significant. A lateral association of these genotypes with thrombophilic risk factors was observed which may be investigated further for the possible pathogenetic mechanisms and their therapeutic implications.

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Diagnostic Value of Plasma Thrombin-Antithrombin III Complex and D-Dimer Concentration in Patients with Varicose Veins for Exclusion of Deep-Vein Thrombosis

Thrombosis Research ◽

10.1016/s0049-3848(98)00081-4 ◽

1998 ◽

Vol 91 (2) ◽

pp. 101-104 ◽

Cited By ~ 6

Author(s):

Tomio Kawasaki ◽

Nobutoshi Shinoki ◽

Shin-ichi Iwamoto ◽

Hironobu Fujimura ◽

Norihide Yoshikawa ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Antithrombin Iii ◽

Varicose Veins ◽

Diagnostic Value ◽

Vein Thrombosis ◽

Deep Vein ◽

Thrombin Antithrombin Iii Complex ◽

D Dimer

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Antiphospholipid antibody profile: implications for the evaluation and management of patients

Lupus ◽

10.1177/0961203310361491 ◽

2010 ◽

Vol 19 (4) ◽

pp. 432-435 ◽

Cited By ~ 20

Author(s):

A. Tincani ◽

L. Andreoli ◽

C. Casu ◽

R. Cattaneo ◽

P. Meroni

Keyword(s):

Pregnancy Loss ◽

Severe Disease ◽

Clinical Manifestations ◽

Diagnostic Value ◽

Antiphospholipid Antibody ◽

Vein Thrombosis ◽

Glycoprotein I ◽

Antibody Assays ◽

Independent Risk Factors ◽

Deep Vein

According to the classification criteria of antiphospholipid syndrome, lupus anticoagulant, anticardiolipin and anti-β2 glycoprotein I antibody assays are independent risk factors for the occurrence of vascular thrombosis and pregnancy loss. However, it is generally accepted that patients carrying multiple positivity have more a severe disease and higher recurrence rate despite treatment. On the other hand, the diagnostic value of a positive result in one only assay is more controversial, particularly in the presence of clinical manifestations such as deep vein thrombosis or early miscarriages, which are rather common in the general population. In this review we speculate on current and future strategies to interpret different antiphospholipid antibody profiles in the clinical practice. Lupus (2010) 19, 432—435.

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Deep vein thrombosis and pulmonary emboli in neurosurgical patients: a review

Journal of Neurosurgery ◽

10.3171/jns.1984.61.6.1055 ◽

1984 ◽

Vol 61 (6) ◽

pp. 1055-1062 ◽

Cited By ~ 68

Author(s):

Karl W. Swann ◽

Peter McL. Black

Keyword(s):

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Anticoagulation Therapy ◽

Screening Tests ◽

Limb Weakness ◽

Prophylactic Measure ◽

Vein Thrombosis ◽

Prophylactic Measures ◽

Neurosurgical Patients ◽

Deep Vein

✓ This review examines the incidence, natural history, diagnosis, prophylaxis, and management of deep vein thrombosis (DVT) and pulmonary embolism (PE) in neurosurgical patients. Recent studies estimate the incidence of postoperative DVT detected by fibrinogen scanning in neurosurgical patients to be 29% to 43%. Specific factors that enhance the risk of venous thromboembolism include previous DVT, surgery, immobilization, advanced age, obesity, limb weakness, heart failure, and lower extremity trauma. Clinical diagnosis of venous thromboembolism is unreliable but can be augmented by noninvasive screening tests such as iodine-125-fibrinogen scanning, Doppler ultrasonography, and impedance plethysmography. As prophylactic measures, mini-dose heparin and external pneumatic compression of the legs have decreased the incidence of DVT in clinical studies of neurosurgical patients. However, no prophylactic measure has been convincingly shown to prevent PE in neurosurgical patients. Thrombi involving the popliteal, deep femoral, and iliac veins appear most likely to cause significant PE. Anticoagulation therapy constitutes standard management of DVT and PE; however, in neurosurgical patients the potential for precipitating intracranial or intraspinal hemorrhage may necessitate vena caval interruption. This appears to be an effective alternative to anticoagulation.

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Diagnostic Value of Neutrophil Lymphocyte Ratio and D-Dimer as Biological Markers of Deep Vein Thrombosis in Patients Presenting with Unilateral Limb Edema

Journal of Blood Medicine ◽

10.2147/jbm.s291226 ◽

2021 ◽

Vol Volume 12 ◽

pp. 313-325

Author(s):

Ikhwan Rinaldi ◽

Rachmat Hamonangan ◽

Mohamad Syahrir Azizi ◽

Rahmat Cahyanur ◽

Fadila Wirawan ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Biological Markers ◽

Diagnostic Value ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Vein Thrombosis ◽

Limb Edema ◽

Deep Vein ◽

D Dimer

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Lumbosacral spondylodiscitis complicated by sepsis, osteomyelitis, epidural abscess formation and deep vein thrombosis

BMJ Case Reports ◽

10.1136/bcr-2020-238522 ◽

2020 ◽

Vol 13 (12) ◽

pp. e238522

Author(s):

Etienne Ceci Bonello ◽

Christian Vassallo ◽

Paul John Cassar

Keyword(s):

Deep Vein Thrombosis ◽

Epidural Abscess ◽

Psoas Abscess ◽

Abscess Formation ◽

Outpatient Basis ◽

Limb Weakness ◽

Ct Guided ◽

Vein Thrombosis ◽

Intravenous Antibiotics ◽

Deep Vein

A 71-year-old man presented with a 3-month history of low back pain radiating to his right hip and thigh associated with lower limb weakness and constitutional symptoms. Imaging confirmed a lumbosacral spondylodiscitis at L2–3 and L5–S1 as well as a right-side psoas abscess which was treated with urgent CT-guided drainage and intravenous antibiotics. His admission was complicated by a number of issues, including the development of osteomyelitis with vertebral body destruction at multiple sites, epidural abscess formation and deep vein thrombosis. Additionally, the patient developed severe sepsis which necessitated admission to the intensive care unit. The patient’s clinical condition improved gradually with intravenous antibiotics until he was well enough for transfer to a rehabilitation centre, where he underwent regular occupational and physical therapy. Repeat imaging showed overall resolution of the aforementioned pathologies and is currently being followed up by the spinal surgeons on an outpatient basis.

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Diagnostic Value Of Ethanol Gelation Test (EGT) For Detection Of Early Deep Vein Thrombosis (DVT) In Patients With Stroke

10.1055/s-0038-1652920 ◽

1981 ◽

Cited By ~ 1

Author(s):

T Hamborg ◽

H C Godal

Keyword(s):

Average Frequency ◽

Diagnostic Value ◽

Sex Distribution ◽

Marked Rise ◽

Duration Of Symptoms ◽

Vein Thrombosis ◽

Motor Paralysis ◽

Completed Stroke ◽

Uptake Test ◽

Deep Vein

In the present study, EGT was applied for detection of fibrinaemia in patients with early DVT, as diagnosed by the 125-I-fibrinogen uptake test (FUT). The study included 25 patients with completed stroke and upper motor paralysis of at least one extremity. Patients who were critically ill, or with duration of symptoms for more than one week, were not included.The isotope was injected at admission and FUT became definitely positive (FUT+) 2-12 (mean 5) days later in 17 patients (68%). In the remaining 8, FUT was negative (FUT−) for 11-14 days. FUT recordings were taken for up to 2 weeks, and EGT was analyzed thrice a week, or at least until DVT was diagnosed. The two groups were comparable in respect with age and sex distribution, mortality and frequency of serious impairment of consciousness.Results: During the study period, EGT was positive at least once in 13 of the 17 FUT+ patients, against only 1 of the 8 FUT− patients (P< 0.02). EGT was positive in 34 (37%) of totally 97 specimens from the FUT+ group, but in only 1 (2%) of 50 specimens from the FUT− group (P<0.001). In the FUT+ group, the frequency of positive EGT increased from about 10 to 70%, with a marked rise three days (day −3) before the first positive FUT (day 0).During the period from day −11 to −4, the average frequency was 13% (3/24), while it was 46% (33/72) in the last period from day −3 to +9). This increase in correlation to the time of first positive FUT, was statistically significant (P<0.01).Conclusion: A positive EGT in moderately ill stroke patients, necessitates further examinations in respect with DVT, as some of these may need anticoagulants to prevent serious embolic complications.

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