Heparin
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Heparin Lack of efficacy: case report
A 74-year-old man exhibited lack of efficacy during treatment with heparin for systemic vascular thrombosis. The man, who had a history of diabetes Mellitus (DM), presented to the emergency department with one day history of lethargy and hypoxia. On arrival at the emergency department, he was febrile, tachycardic and tachypnoeic. Due to impaired oxygen saturation, he required emergent intubation and mechanical ventilation. He received vigorous IV fluid resuscitation followed by inotropic support with norepinephrine. On the subsequent day, a real-time polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) showed positive result. He received off-label treatment with hydroxychloroquine. On day 2, he developed bilateral lower extremity oedema. Doppler ultrasound (DUS) showed widespread occlusive thrombosis in the right femoral and bilateral popliteal veins. DUS of the upper extremities also showed occlusive thrombi in the right cephalic and left basilic vein. For systemic vascular thrombosis, he immediately received IV heparin [unfractionated heparin, dosage not stated]. Despite the heparin treatment, an arterial DUS of the lower extremities revealed massive occlusive thrombi in the bilateral common femoral, profundal femoris, superficial femoral, posterior tibial, peroneal and posterior tibial arteries. In view of the extensive clot burden indicating heparin failure, the man’s anticoagulant treatment was switched to argatroban. He was suspected as a poor candidate for catheter-directed thrombolysis or vascular bypass surgery; hence, he underwent bilateral femoral endarterectomy followed by thrombectomy. Despite this measures, he eventually required above knee lower extremity amputations. His hospital course was further complicated by rhabdomyolysis, diffuse coagulopathy and a urinary tract infection along with COVID-19. In view of clinical deterioration, his family opted for comfort measures, and he was transferred to a hospice facility. Ali Z, et al. Acute COVID-19 induced fulminant systemic vascular thrombosis: A novel entity. IJC Heart and Vasculature 30: Oct 2020. Available from: URL: http:// doi.org/10.1016/j.ijcha.2020.100620
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Reactions 17 Oct 2020 No. 1826
