The problem of inpatient thrombosis of coronary arteries in patients with COVID-19 on the background of intensive antithrombotic therapy
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https://orcid.org/0000-0002-8982-7578
Abstract
Myocardial infarction claims million lives on the planet each year. Pharmacotherapy in combination with percutaneous coronary interventions have significantly reduced morbidity and mortality in this cohort. Despite optimal therapy and prophylaxis, there is a group of patients with recurrent, often fatal, coronary thromboses. During the COVID-19 pandemic, some patients developed episodes of thrombosis in blood vessels of various organs, including brain, heart or lungs, even on therapeutic anticoagulation. The patient was admitted to the department of cardiology and reperfusion therapy, with a confirmed diagnosis of COVID-19 resulted in acute ST-segment elevation myocardial infarction. Patient underwent urgent coronary angiography with thromboaspiration and stenting of the infarct-dependent right coronary artery followed by optimal medical treatment with the use of triple antithrombotic therapy. His condition became stable with the resolution of ST-segment elevation on electrocardiogram. A few days later, the condition of the patient deteriorated again with recurrent of chest pain and a new ST segment elevation. Repeated coronary angiography revealed recurrent thrombosis in the right coronary artery. The mechanisms of thrombosis in COVID-19 are not fully understood. Among possible, the direct effect of the virus on tissues, activation of pro-inflammatory system and coagulation system, impaired vasodilation, and decreased fibrinolytic activity are discussed. These mechanisms may lead to vascular thrombosis in different organs, particularly heart, lungs, and brain.
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«Zhyva» klinichna nastanova [Elektronnyi resurs]: klinichna nastanova Ministerstva okhorony zdorovia Ukrainy vid 2021 r. URL:https://www.dec.gov.ua/wp-content/uploads/2021/01/2021_01_kn_covid-19.pdf)
Abate SM, Mantefardo B, Nega S, Chekole YA, Basu B, Ali SA, Taddesse M. Global burden of acute myocardial injury associated with COVID-19: A systematic review, meta-analysis, and meta-regression. Annals of Medicine and Surgery. 2021:68 HTTPS://DOI.ORG/10.1016/j.amsu.2021.102594
Al Shahrani I, Hosmani J, Shankar VG, AlShahrani A, Togoo RA, Yassin SM. COVID-19 and cardiovascular system-a comprehensive review. Rev Cardiovasc Med. 2021: Jun;22(2):343-51. https://doi.org/10.31083/j.rcm2202041.
Asakura H, Ogawa H. COVID-19-associated coagulopathy and disseminated intravascular coagulation. Int J Hematol. 2021; 113(1): 45-57. https://doi.org/10.1007/s12185-020-03029-y
Bílková S, Hirmerová J. Coagulopathy associated with COVID-19.Vnitr Lek. 2020 Fall;66(7):402-8.
Fu H, Vadalia N, Xue ER, Johnson C, Wang L, Yang WY, Sanchez C, Nelson J, Chen Q, Choi ET, Ma J-X, Yu J, Wang H, Yang X. Thrombus leukocytes exhibit more endothelial cell-specific angiogenic markers than peripheral blood leukocytes do in acute coronary syndrome patients, suggesting a possibility of trans-differentiation: a comprehensive database mining study. J Hematol Oncol. 2017 Mar;10(74). https://doi.org/10.1186/s13045-017-0440-0
Gerotziafas GT, Catalano M, Colgan MP, Pecsvarady Z, Wautrecht JC, Fazeli B. Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology. Vascular Med. 2020 Dec;120(12):1597-628. https://doi.org/10.1055/s-0040-1715798
Hanff CT, Mohareb MA, Giri J, Cohen BJ, Chirinos AJ. Thrombosis in COVID-19. Am J Hematol. 2020.Dec;95(12):1578-89. https://doi.org/10.1002/ajh.25982
Jiang L, Li Y, Du H, Qin Z, Su B. Effect of Anticoagulant Administration on the Mortality of Hospitalized Patients With COVID-19: An Updated Systematic Review and Meta-Analysis. Front Med (Lausanne). 2021;8:698935. https://doi.org/10.3389/fmed.2021.698935
Loo J, Spittle AD, Newnham M. COVID-19, immunothrombosis and venous thromboembolism: biological mechanisms.Thorax. 2021 Apr;76(4):412-20. https://doi.org/10.1136/thoraxjnl-2020-216243
Lopes RD, de Silva PG, Furtado RH, Macedo S, Bronhara B, Damiani LP, et al. Therapeutic versus prophylactic anticoagulation for patients admitted to hospital with COVID-19 and elevated D-dimer concentration (ACTION): an open-label, multicentre, randomised, controlled trial. The Lancet. 2021June; 397(0291):2253-63. HTTPS://DOI.ORG/https://doi.org/10.1016/S0140-6736(21)01203-4
Louis DW, Saad M, Vijayakumar S, Ilyas S, Kokkirala A, Aronow AD. The Cardiovascular Manifestations of COVID-19. Heart Fail Clin. 2023 Apr;19(2):153-61. https://doi.org/10.1016/j.hfc.2022.08.001
Mohammad AM, Spinler SA. COVID-19 and thrombosis: From bench to bedside Trends Cardiovasc Med. 2021 Apr;31(3):143-60. https://doi.org/10.1016/j.tcm.2020.12.004
Tousoulis D, Davies G, Stefanadis C, Toutouzas P, Ambrose JA. Inflammatory and thrombotic mechanisms in coronary atherosclerosis. Heart. 2003 Sep;89(9):993-7. https://doi.org/10.1136/heart.89.9.993