Post-COVID-19 tibial and fibular arterial thrombosis: therapeutic approaches

Abstract

Introduction: Current evidence suggests that hypercoagulability may be a sequel to hyperinflammation, a key pathogenic mechanism that contributes to increased mortality in COVID-19. The objective of this study was to report a case of arterial occlusion of the tibial arteries 21 days after hospital discharge from COVID-19 and analyze the approach. Report: Female patient with 47 years old was admitted to the infirmary with COVID-19 for 21 days, without other comorbidities. The patient had no history of previous disease or family thrombotic events. During this period, she had prophylaxis with enoxaparin 40 mg 12/12. The D-dimer assessment was performed routinely, without evident changes. Five days after leaving the hospital had symptoms of pain in the left limb. In clinical evaluation, the femoral and popliteal pulses were palpable, but distally, there was no pulse or flow at the bedside Doppler. The embolization was successful, and a significant amount of thrombus was removed; the appearance of a posterior tibial pulse was noted at the end of the procedure. She remained under full heparinization for 72 hours for transition to oral anticoagulation and hospital discharge with significant clinical improvement, leaving only moderate pain when walking. In the first return patient, have discrete pain with walking, but all palpable and symmetrical pulses, and full anticoagulation is maintained. Conclusion: Acute arterial occlusion in COVID-19 has a new etiology, and we know little about its behavior. The therapeutic approach differs from the arteriosclerotic cause, mainly regarding the anticoagulation time, which has no definition in the literature.