Prosthetic valve thrombosis in a patient secondary to COVID-19: a case report
DOI:
https://doi.org/10.14739/2310-1210.2024.5.306950Keywords:
prosthetic valve, thrombosis, COVID-19, hypercoagulation, aortic insufficiency, heart failureAbstract
A well-known and dangerous complication of COVID-19 infection is the development of hypercoagulation, which leads to thrombosis of various localization. Therefore, the problem of anticoagulant therapy was widely discussed during the first months of the pandemic and continues to be relevant. At the same time, concomitant cardiac pathology is associated with a more severe course of COVID-19 and higher risks of complications and mortality. Therefore, patients who underwent cardiac surgery require special attention. Individuals with prosthetic metal heart valves must constantly receive anticoagulant therapy, however, the literature describes cases of intracardiac thrombotic complications despite anticoagulation during COVID-19 infection. Currently, there are no randomized studies on this issue, and only individual clinical cases provide this information.
The aim of the work was to describe a clinical case of thrombosis at the left ventricular apex during COVID-19 infection in a patient with a prosthetic aortic valve who received adequate warfarin therapy and to compare the tactics of patient management and therapeutic outcomes with other clinical cases.
Materials and methods. The patient was followed-up after aortic valve replacement for 2 years. During the visits, a general clinical examination, laboratory examinations – clinical blood test, blood glucose, urea, creatinine, bilirubin, INR, NT-proBNP, echocardiography were performed.
Results. The patient with a congenital heart defect, a condition after aortic valve replacement, mitral and tricuspid valve annuloplasty (15.03.2022) due to bicuspid aortic valve, combined aortic defect with predominance of stage III-IV regurgitation; stage III secondary arterial hypertension; chronic heart failure IIA, functional class III, stage C, reduced systolic left ventricular function; a two-chamber pacemaker due to complete AV blockade; paroxysmal atrial flutter presented to a cardiologist with worsening shortness of breath and weakness one month after a moderate COVID-19 infection. The patient received bisoprolol 5 mg, amiodarone 200 mg, spironolactone 50 mg, perindopril 8 mg, warfarin 5 mg, INR was carefully controlled, at presentation – 3.7. Echocardiography revealed a left ventricular apex thrombus, a decrease in left ventricular ejection fraction (LVEF) from 46 % to 38 %. Aspirin 75 mg/day, torasemide 10 mg/day, dapagliflozin 10 mg/day, and metabolic therapy were added to the treatment. After 1 month, the patient’s condition improved, no thrombus was detected in the left ventricular cavity, LVEF increased to 46 %.
Conclusions. This case demonstrates the problem of careful cardiovascular system state monitoring in patients with prosthetic valves during and after COVID-19, since symptoms of heart cavity or valve thrombosis, worsening heart failure can be mistakenly considered as signs of a viral infection or respiratory failure.
References
Hendren NS, Drazner M, Bozkurt B, Cooper LT. Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome. Circulation. 2020;141(23):1903-14. doi: https://doi.org/10.1161/CIRCULATIONAHA.120.047349
Ranard LS, Fried JA, Abdalla M, Anstey DE, Givens RC, Kumaraiah D, et al. Approach to Acute Cardiovascular Complications in COVID-19 Infection. Circ Heart Fail. 2020;13(7):e007220. doi: https://doi.org/10.1161/CIRCHEARTFAILURE.120.007220
Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020;18(6):1421-4. doi: https://doi.org/10.1111/jth.14830
Poissy J, Goutay J, Caplan M, Parmentier E, Duburcq T, Susen S. Pulmonary Embolism in Patients With COVID-19. Circulation. 2020;142(2):184-6. doi: https://doi.org/10.1161/circulationaha.120.047430
Malas MB, Naazie IN, Elsayed N, Mathlouthi A, Marmor R, Clary B. Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis. EClinicalMedicine. 2020;29:100639. doi: https://doi.org/10.1016/j.eclinm.2020.100639
Letko M, Marzi A, Munster V. Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B betacoronaviruses. Nat Microbiol. 2020;5(4):562-9. doi: https://doi.org/10.1038/s41564-020-0688-y
Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417-8. doi: https://doi.org/10.1016/S0140-6736(20)30937-5
McGonagle D, Sharif K, O’Regan A, Bridgewood C. The Role of Cytokines including Interleukin-6 in COVID-19 induced Pneumonia and Macrophage Activation Syndrome-Like Disease. Autoimmun Rev. 2020;19(6):102537. doi: https://doi.org/10.1016/j.autrev.2020.102537
Ahmed S, Zimba O, Gasparyan AY. Thrombosis in Coronavirus disease 2019 (COVID-19) through the prism of Virchow’s triad. Clin Rheumatol. 2020;39(9):2529-43. doi: https://doi.org/10.1007/s10067-020-05275-1
Semeraro N, Ammollo CT, Semeraro F, Colucci M. Coagulopathy of Acute Sepsis. Semin Thromb Hemost. 2015;41(6):650-8. doi: https://doi.org/10.1055/s-0035-1556730
Wright FL, Vogler TO, Moore EE. Fibrinolysis shutdown correlates to thromboembolic events in severe COVID-19 infection. J Am Coll Surg. 2020;231(2):193-203. doi: https://doi.org/10.1016/j.jamcollsurg.2020.05.0077
Ma AC, Kubes P. Platelets, neutrophils, and neutrophil extracellular traps (NETs) in sepsis. J Thromb Haemost. 2008;6(3):415-20. doi: https://doi.org/10.1111/j.1538-7836.2007.02865.x
Manghat NE, Hamilton MCK, Joshi NV, Vohra HA. Acute postoperative thrombosis of an aortic valve prosthesis and embolic myocardial infarction in a coronavirus disease 2019 (COVID-19)-positive patient-an unrecognized complication. JTCVS Tech. 2020;4:111-3. doi: https://doi.org/10.1016/j.xjtc.2020.09.020
Stefely JA, Christensen BB, Gogakos T, Cone Sullivan JK, Montgomery GG, Barranco JP, et al. Marked factor V activity elevation in severe COVID-19 is associated with venous thromboembolism. Am J Hematol. 2020;95(12):1522-30. doi: https://doi.org/10.1002/ajh.25979
Zuo Y, Yalavarthi S, Shi H, Gockman K, Zuo M. Neutrophil extracellular traps in COVID-19. JCI Insight. 2020;5(11):e138999. https://doi.org/10.1172/jci.insight.138999
Magro C, Mulvey J, Berlin D, Nuovo G, Salvatore S, Harp J, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Transl Res. 2020;220:1-13. doi: https://doi.org/10.1016/j.trsl.2020.04.007
Panigada M, Bottino N, Tagliabue P, Grasselli G, Novembrino C, Chantarangkul V, et al. Hypercoagulability of COVID-19 patients in intensive care unit: A report of thromboelastography findings and other parameters of hemostasis. J Thromb Haemost. 2020;18(7):1738-42. doi: https://doi.org/10.1111/jth.14850
Barnes GD, Burnett A, Allen A, Blumenstein M, Clark NP, Cuker A, et al. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J Thromb Thrombolysis. 2020;50(1):72-81. doi: https://doi.org/10.1007/s11239-020-02138-z
Omidi N, Forouzannia SK, Poorhosseini H, Tafti SH, Salehbeigi S, Lotfi-Tokaldany M. Prosthetic heart valves and the COVID-19 pandemic era: What should we be concerned about? J Card Surg. 2020;35(10):2500-5. doi: https://doi.org/10.1111/jocs.14707
Colling ME, Kanthi Y. COVID-19-associated coagulopathy: An exploration of mechanisms. Vasc Med. 2020;25(5):471-8. doi: https://doi.org/10.1177/1358863X20932640
Zhai Z, Li C, Chen Y, Gerotziafas G, Zhang Z, Wan J, et al. Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines. Thromb Haemost. 2020;120(6):937-48. doi: https://doi.org/10.1055/s-0040-1710019
Bikdeli B, Madhavan MV, Gupta A, Jimenez D, Burton JR, Der Nigoghossian C, et al. Pharmacological Agents Targeting Thromboinflammation in COVID-19: Review and Implications for Future Research. Thromb Haemost. 2020;120(7):1004-24. doi: https://doi.org/10.1055/s-0040-1713152
Gisbert G, Urrutia V, Benita MA, Chaume A, Jofresa A, Arango A, et al. Bioprosthetic Valve Thrombosis and Obstruction Secondary to COVID-19. Can J Cardiol. 2021;37(6):938.e3-938.e6. doi: https://doi.org/10.1016/j.cjca.2020.10.008
Trieu TK, Birkeland K, Kimchi A, Kedan I. Comprehensive collection of COVID-19 related prosthetic valve failure: a systematic review. J Thromb Thrombolysis. 2023;55(3):474-89. doi: https://doi.org/10.1007/s11239-022-02746-x
Allione A, Giamello JD, Bernardi S, Paglietta G, Cavalot GL, Dutto LA, et al. Coronavirus disease 2019 (COVID-19) and prosthetic heart valve: An additional coagulative challenge. World J Emerg Med. 2020;11(4):258-9. doi: https://doi.org/10.5847/wjem.j.1920-8642.2020.04.009
Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739-91. doi: https://doi.org/10.1093/eurheartj/ehx391
Whitlock RP, Sun JC, Fremes SE, Rubens FD, Teoh KH. Antithrombotic and thrombolytic therapy for valvular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e576S-e600S. doi: https://doi.org/10.1378/chest.11-2305
Kow C, Sunter W, Bain A, Zaidi S, Hasan S. Management of Outpatient Warfarin Therapy amid COVID-19 Pandemic: A Practical Guide. Am J Cardiovasc Drugs. 2020;26:1-9. doi: https://doi.org/10.1007/s40256-020-00415-z
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