Elsevier

Annals of Vascular Surgery

Volume 68, October 2020, Pages 88-92
Annals of Vascular Surgery

COVID 19
A Case of Covid-19 Patient with Acute Limb Ischemia and Heparin Resistance

https://doi.org/10.1016/j.avsg.2020.06.046Get rights and content

Highlights

  • Heparin resistance is a phenomenon defined as the need for high-dose unfractionated heparin to achieve the target activated partial-thromboplastin time ratio.

  • This case aims to describe a Covid-19 patient with acute limb ischemia who developed heparin resistance.

  • Covid-19 infection is a systemic endothelial disease not limited to the lungs.

  • Anticoagulation cannot be managed as one-size-fits-all owing to the coexistence of several “sheds of thrombophilia” (i.e. HR, deficiency of antithrombin III).

Heparin resistance is an uncommon phenomenon defined as the need for high-dose unfractionated heparin (UFH) of more than 35,000 IU/day to achieve the target activated partial-thromboplastin time ratio or the failure to achieve the desired activated clotting time after a full UFH dose. This rare phenomenon is being more commonly observed in Covid-19 patients in a hypercoagulable state. We describe a Covid-19 patient confirmed by reverse-transcriptase polymerase chain reaction assay, with acute limb ischemia, who developed heparin resistance. The patient was managed by the departments of vascular surgery, anesthesia and intensive care, and the Coagulation Service and Thrombosis Research from San Raffaele Scientific Institute, Milan, Italy.

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Conflicts of Interest: The authors have no relevant conflicts for the present work.

Authors' contributions: Domenico Baccellieri, Victor Bilman, Luca Apruzzi, Fabrizio Monaco, Armando D’Angelo, and Diletta Loschi contributed to the concept, analysis/interpretation of data, critical writing, and revising intellectual content. Germano Melissano and Roberto Chiesa contributed to the concept, critical writing, and revising intellectual content.

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