tetano
Editor, Senior Moderator
Cureus
. 2021 Jul 4;13(7):e16162.
doi: 10.7759/cureus.16162. eCollection 2021 Jul.
Acute Limb Ischemia Complicated by Heparin-Induced Thrombocytopenia in an Asymptomatic COVID-19 Patient
Nabeel A Siddiqui[SUP] 1 [/SUP], Enkhmaa Luvsannyam[SUP] 1 [/SUP], Molly S Jain[SUP] 2 [/SUP], Muhammad Abbas[SUP] 3 [/SUP], Arathi Jayaraman[SUP] 4 [/SUP], Redjon Zhuleku[SUP] 5 [/SUP], Nayaab Ullah[SUP] 6 [/SUP], Alma Corona[SUP] 7 [/SUP], Mohammad T Hussain[SUP] 7 [/SUP]
Affiliations
Abstract
Acute limb ischemia (ALI) is the sudden decrease in limb perfusion caused by embolism secondary to many blood stasis conditions. Treatment commences with intravenous (IV) unfractionated heparin infusion. Individuals can have an immune-mediated reaction to heparin products which results in heparin-induced thrombocytopenia (HIT). Coronavirus disease 2019 (COVID-19) has added to the difficulty of treating patients with ALI due to increasing the likelihood of HIT via the virus's ability to manipulate the coagulation parameters. We present a case of ALI complicated by HIT in a 49-year-old male with a confirmed asymptomatic COVID-19. The patient initially presented with progressive pain, coldness, and tingling in the right foot. He was treated with a tissue plasminogen activator (TPA) and a heparin drip. The occlusion persisted despite medical intervention leading to right below-knee amputation. The patient returned to the emergency department (ED) 13 days later with massive intracranial hemorrhage and subsequently expired. This case study demonstrates the significance of COVID-19 diagnostic testing due to the possibility of developing blood clots and potential complications, including HIT.
Keywords: acute limb ischemia; anticoagulation; coronavirus; covid-19; heparin-induced thrombocytopenia; rutherford classifications.
. 2021 Jul 4;13(7):e16162.
doi: 10.7759/cureus.16162. eCollection 2021 Jul.
Acute Limb Ischemia Complicated by Heparin-Induced Thrombocytopenia in an Asymptomatic COVID-19 Patient
Nabeel A Siddiqui[SUP] 1 [/SUP], Enkhmaa Luvsannyam[SUP] 1 [/SUP], Molly S Jain[SUP] 2 [/SUP], Muhammad Abbas[SUP] 3 [/SUP], Arathi Jayaraman[SUP] 4 [/SUP], Redjon Zhuleku[SUP] 5 [/SUP], Nayaab Ullah[SUP] 6 [/SUP], Alma Corona[SUP] 7 [/SUP], Mohammad T Hussain[SUP] 7 [/SUP]
Affiliations
- PMID: 34367772
- PMCID: PMC8330877
- DOI: 10.7759/cureus.16162
Abstract
Acute limb ischemia (ALI) is the sudden decrease in limb perfusion caused by embolism secondary to many blood stasis conditions. Treatment commences with intravenous (IV) unfractionated heparin infusion. Individuals can have an immune-mediated reaction to heparin products which results in heparin-induced thrombocytopenia (HIT). Coronavirus disease 2019 (COVID-19) has added to the difficulty of treating patients with ALI due to increasing the likelihood of HIT via the virus's ability to manipulate the coagulation parameters. We present a case of ALI complicated by HIT in a 49-year-old male with a confirmed asymptomatic COVID-19. The patient initially presented with progressive pain, coldness, and tingling in the right foot. He was treated with a tissue plasminogen activator (TPA) and a heparin drip. The occlusion persisted despite medical intervention leading to right below-knee amputation. The patient returned to the emergency department (ED) 13 days later with massive intracranial hemorrhage and subsequently expired. This case study demonstrates the significance of COVID-19 diagnostic testing due to the possibility of developing blood clots and potential complications, including HIT.
Keywords: acute limb ischemia; anticoagulation; coronavirus; covid-19; heparin-induced thrombocytopenia; rutherford classifications.