Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.200234
Jornal Vascular Brasileiro
Case Report

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

Downloads: 1
Views: 1027

Resumo

Resumo: A infecção pelo coronavírus 2 causador da síndrome respiratória aguda grave (SARS-CoV-2) em humanos foi detectada pela primeira vez em Wuhan, na China, em 2019 e dispersada mundialmente ao longo de 2020. As diferentes manifestações clínicas, com amplo espectro de apresentação, desde infecções assintomáticas até formas graves que podem levar a óbito, são desafiadoras. Este trabalho objetiva descrever uma série de quatro casos de isquemia arterial aguda dos membros superiores em pacientes diagnosticados com COVID-19, os quais foram manejados clinicamente com anticoagulação, antiagregação plaquetária e uso de prostanoides. Dois pacientes receberam alta hospitalar com regressão e delimitação da área isquêmica, sem necessidade de intervenção cirúrgica, e dois pacientes faleceram em decorrência de complicações pulmonares. Uma adequada compreensão da fisiopatologia dessa doença pode favorecer um melhor manejo clínico de suas complicações.

Palavras-chave

COVID-19, anticoagulantes, embolia e trombose, isquemia, prostaglandinas

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

COVID-19; anticoagulants; emboli and thrombosis; ischemia; prostaglandins.

References

1 World Health Organization [site da Internet]. Coronavirus disease (COVID-19). 2020 [atualizado 2020 nov 26; citado 2020 dez 3]. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public.

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. http://dx.doi.org/10.1016/S0140-6736(20)30183-5. PMid:31986264.

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. http://dx.doi.org/10.1056/NEJMoa2001017. PMid:31978945.

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. http://dx.doi.org/10.1111/jth.14768. PMid:32073213.

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. http://dx.doi.org/10.1515/cclm-2020-0188. PMid:32172226.

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. http://dx.doi.org/10.1016/S0140-6736(20)30566-3. PMid:32171076.

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. http://dx.doi.org/10.1016/j.apsb.2020.04.008. PMid:32318327.

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. http://dx.doi.org/10.1016/j.trsl.2020.04.007. PMid:32299776.

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. http://dx.doi.org/10.1111/jth.14817. PMid:32220112.

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. http://dx.doi.org/10.1016/j.jacc.2020.05.001. PMid:32387623.

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. http://dx.doi.org/10.1056/NEJMc2013656. PMid:32369280.

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. http://dx.doi.org/10.1016/S0140-6736(20)30628-0. PMid:32192578.

13 Colling ME, Kanthi Y. COVID-19-associated coagulopathy: an exploration of mechanisms. Vasc Med. 2020;25(5):471-8. http://dx.doi.org/10.1177/1358863X20932640. PMid:32558620.

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. http://dx.doi.org/10.1016/j.imbio.2014.10.008. PMid:25454806.

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. http://dx.doi.org/10.1371/journal.pone.0126763. PMid:25961885.

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. http://dx.doi.org/10.1111/jth.14902. PMid:32408391.

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. http://dx.doi.org/10.1016/j.jacc.2020.04.031. PMid:32311448.

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. http://dx.doi.org/10.1177/0003319719889273. PMid:31769315.

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. http://dx.doi.org/10.1590/1677-5449.200072.

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. http://dx.doi.org/10.1016/j.jvs.2020.04.483. PMid:32360679.
 


Submitted date:
01/11/2021

Accepted date:
03/17/2021

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
60c9ebd0a9539538651fa384 jvb Articles

J Vasc Bras

Share this page
Page Sections