Isquemia arterial aguda de membros superiores em pacientes diagnosticados com COVID-19: série de casos
Acute upper limb arterial ischemia in patients diagnosed with COVID-19: case series
Felipe Damascena Rosa; Marcelo Calil Burihan; Elexandra Aparecida Simões; João Paulo de Souza Abdala; Orlando da Costa Barros; Felipe Nasser
Resumo
Palavras-chave
Abstract
Infection by coronavirus 2, cause of the severe acute respiratory syndrome (SARS-CoV-2) in humans, was detected for the first time in Wuhan, China, in 2019, and spread globally over the course of 2020. Its different clinical manifestations are challenging, with a wide spectrum of presentations, ranging from asymptomatic infections to severe forms that can result in death. The objective of this study is to describe a series of four cases of acute arterial ischemia involving the upper limbs in patients diagnosed with COVID-19, which were managed clinically with anticoagulation, platelet antiaggregation, and prostanoids. Two patients were discharged from hospital with regression and delimitation of the ischemic zone, without needing surgical intervention, while two patients died from pulmonary complications. Adequate understanding of the pathophysiology of this disease could support better clinical management of its complications.
Keywords
References
1 World Health Organization [site da Internet]. Coronavirus disease (COVID-19). 2020 [atualizado 2020 nov 26; citado 2020 dez 3].
2 Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
3 Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33.
4 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;18(4):844-7.
5 Han H, Yang L, Liu R, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med. 2020;58(7):1116-20.
6 Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;320(10229):1054-62.
7 Liu X, Li Z, Liu S, et al. Potential therapeutic effects of dipyridamole in the severely ill patients with COVID-19. Acta Pharm Sin B. 2020;10(7):1205-15.
8 Magro C, Mulvey JJ, Berlin D, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Trans. Res. 2020;220:1-13.
9 Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18(5):1094-9.
10 Paranjpe I, Fuster V, Lala A, et al. Association of treatment dose anticoagulation with in-hospital survival among hospitalized patients with COVID-19. J Am Coll Cardiol. 2020;76(1):122-4.
11 Bowles L, Platton S, Yartey N, et al. Lupus anticoagulant and abnormal coagulant tests in patients with COVID-19. N Engl J Med. 2020;383(3):288-90.
12 Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-4.
13 Colling ME, Kanthi Y. COVID-19-associated coagulopathy: an exploration of mechanisms. Vasc Med. 2020;25(5):471-8.
14 Li X, Liu Y, Wang L, Li Z, Ma X. Unfractionated heparin attenuates LPS-induced IL-8 secretion via PI3K/Akt/NF-kB signaling pathway in human endothelial cells. Immunobiology. 2015;220(3):399-405.
15 Shastri MD, Stewart N, Horne J, et al. In-vitro suppression of IL-6 and IL-8 release from human pulmonary epithelial cells by non-anticoagulant fraction of enoxaparin. PLoS One. 2015;10(5):e0126763.
16 Menezes-Rodrigues FS, Tavares JGP, Oliveira MP, et al. Anticoagulant and antiarrhythmic effects of heparin in the treatment of COVID-19 patients. J Thromb Haemost. 2020;18(8):2073-5.
17 Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-Up: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(23):2950-73.
18 Meini S, Dentali F, Melillo E, de Donato G, Mumoli N, Mazzone A. Prostanoids for critical limb ischemia: a clinical review and consideration of current guideline recommendations. Angiology. 2020;71(3):226-34.
19 Manhanelli M Fo, Duarte E Jr, Mariuba J, et al. Alprostadil associated with low molecular weight heparin to treat limb ischemia caused by SARS-CoV2. J Vasc Bras. 2020;19:e20200072.
20 Bellosta R, Luzzani L, Natalini G, et al. Acute limb ischemia in patients with COVID-19 pneumonia. J Vasc Surg. 2020;72(6):1864-72.
Submitted date:
01/11/2021
Accepted date:
03/17/2021