Coronavirus Infection Induced Coagulopathy As A Trigger Factor Of Arterial Thrombosis In Patient With Atherosclerotic Risk Factor: A Case Report

Irma Kamelia, Heny Martini, Novi Kurnianingsih, Indra Prasetya


Background : A newly emerging pandemic of Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus 2 is responsible for significant morbidity and mortality worldwide. As one of the effects is hematological changes related to the COVID-19 infection causing patient tend to thrombosis than hemorrhagic. Current review of evidence and statements on management of coagulopathy and thrombotic complications related to this novel disease is needs to be explored

Case : Male 53 years old referred from Private Hospital, due to Severe pneumonia due to COVID-19 and Acute Limb Ischemia. This patient was assessed as Pneumonia COVID-19 severe with acute limb ischemia bilateral grade IIB and performed bilateral surgical thrombectomy with antegrade approach using fogarty catheter with the result was thrombus 10cm along the left femoral artery and thrombus 2cm in the right femoral artery. Discussion : With consideration of atherosclerotic diseases in this patient, we decided to give rivaroxaban as an anticoagulant combined with aspilet and statin high dose. But due to lack of source in our hospital, and patient also denied for further management, treatment for the patient cannot be optimal, so the patient discharge with unresolved limb ischemia.

Conclusion : This case showed that the increase risk of heparin resistance in SARS-CoV-2 patient, it is recommend- ed to monitor heparin activity of UFH treatment based on anti-Xa levels instead of aPTT alone


coronavirus infection; coagulopathy; acute limb ischemia; thromboembolism; arterial thrombosis

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Barnes GD, Burnett A, Allen A, Blumenstein M, Clark NP, Cuker A, et al. Thromboembolism and Anticoagulant Therapy During the COVID-19 Pandemic: Interim Clinical Guidance from the Anticoag- ulation Forum. J Thromb Thrombolysis. 2020;

Marco Marietta, Coluccio V, Luppi M. COVID-19, coagulopathy and venous thromboembolism: more questions than answers. Intern Emerg Med. 2020;

Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol J. 2020;

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in

Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–62.

Han H, Yang L, Liu R, Liu F, Wu K, Li J, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. de Gruyter. 2020;

Klok FA, Kruip MJHA, Van Der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;

Bellosta R, Luzzani L, Natalini G, Pegorer MA, Attisani L, Cossu LG, et al. Acute limb ischemia in patients with COVID-19 pneumonia. J Vasc Surg. 2020;1–9.

Perini P, Nabulsi B, Massoni CB, Azzarone M, Freyrie A. Acute limb ischaemia in two young, non-atherosclerotic patients with COVID-19. 2020;395:1546.

Hall JE. Hemostasis and Blood Coagulation. In: Textbook of Medical Physiology. 13th ed. Philadelphia: Elsevier; 2016. p. 483–94.

White D, MacDonald S, Bull1 T, Hayman M, Monteverde-Robb R, De Sapsford D, et al. Heparin resistance in COVID-19 patients in the intensive care unit. J Thromb Thrombolysis. 2020;50:287–91.

Beun R, Kusadasi N, Sikma M, Westerink J, Huisman A. Thrombo- embolic events and apparent heparin resistance in patients infected with SARS-CoV-2. Int J Lab Hematol. 2020;42(s1):19–20.

Farkas J. Unfractionated heparin (UFH), LMWH, fondaparinux, argatroban, and bivalirudin. 2020.

PangarsaEA,SetiawanB,SantosaD,NaibahoRM,RizkyD,Suyono, et al. Position paper from the Indonesian Society of Thrombosis and Hemostasis (InaSTH), Semarang chapter: Management of coagu- lopathy in COVID-19. Bali Med J. 2020;2020(2):306–12



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