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Acute ophthalmic artery occlusion in a COVID-19 patient on apixaban
We report a case of ophthalmic artery occlusion (OAO) in a young patient with COVID-19 infection that was on therapeutic anticoagulation with apixaban for deep venous thrombosis (DVT). A 48-year-old man with obesity was hospitalized with a severe form of COVID-19 infection, complicated with acute re...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier Inc.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245224/ https://www.ncbi.nlm.nih.gov/pubmed/32689586 http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104982 |
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author | Dumitrascu, Oana M. Volod, Oksana Bose, Swaraj Wang, Yao Biousse, Valérie Lyden, Patrick D. |
author_facet | Dumitrascu, Oana M. Volod, Oksana Bose, Swaraj Wang, Yao Biousse, Valérie Lyden, Patrick D. |
author_sort | Dumitrascu, Oana M. |
collection | PubMed |
description | We report a case of ophthalmic artery occlusion (OAO) in a young patient with COVID-19 infection that was on therapeutic anticoagulation with apixaban for deep venous thrombosis (DVT). A 48-year-old man with obesity was hospitalized with a severe form of COVID-19 infection, complicated with acute respiratory failure, septic shock, dilated cardiomyopathy and fungemia. Despite treatment with prophylactic enoxaparin (initial D-Dimer 1.14 µg/ml FEU (normal < 0.05 µg/ml FEU), D-Dimer increased to above 20 µg/ml FEU and patient continued to spike high fevers. This prompted further investigations and upper and lower extremities DVTs were confirmed and managed with enoxaparin 1 mg/kg twice daily. D-dimer level decreased to 4.98 µg/ml FEU while on therapeutic anticoagulation. Three weeks later pending hospital discharge, the anticoagulation was switched to oral apixaban 10 mg twice daily. Patient developed acute severe right eye visual loss of no light perception and was diagnosed with incomplete OAO. D-Dimer was elevated at 2.13 µg/ml FEU. Stroke etiological work-up found no embolic sources, resolution of the dilated cardiomyopathy and negative antiphospholipid antibodies. Treatment was changed to enoxaparin and no thrombotic events were encountered to date. Ocular vascular complications have not yet been reported in COVID-19. Controversy exists on the best management algorithm for the hypercoagulable state associated to COVID-19 Either direct oral anticoagulants or low-molecular-weight-heparin are considered appropriate at discharge for patients with venous thromboembolism. The optimum regimen for ischemic stroke prevention and the significance of D-Dimer for anticoagulation monitoring in COVID-19 remain unclear. |
format | Online Article Text |
id | pubmed-7245224 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-72452242020-05-26 Acute ophthalmic artery occlusion in a COVID-19 patient on apixaban Dumitrascu, Oana M. Volod, Oksana Bose, Swaraj Wang, Yao Biousse, Valérie Lyden, Patrick D. J Stroke Cerebrovasc Dis Article We report a case of ophthalmic artery occlusion (OAO) in a young patient with COVID-19 infection that was on therapeutic anticoagulation with apixaban for deep venous thrombosis (DVT). A 48-year-old man with obesity was hospitalized with a severe form of COVID-19 infection, complicated with acute respiratory failure, septic shock, dilated cardiomyopathy and fungemia. Despite treatment with prophylactic enoxaparin (initial D-Dimer 1.14 µg/ml FEU (normal < 0.05 µg/ml FEU), D-Dimer increased to above 20 µg/ml FEU and patient continued to spike high fevers. This prompted further investigations and upper and lower extremities DVTs were confirmed and managed with enoxaparin 1 mg/kg twice daily. D-dimer level decreased to 4.98 µg/ml FEU while on therapeutic anticoagulation. Three weeks later pending hospital discharge, the anticoagulation was switched to oral apixaban 10 mg twice daily. Patient developed acute severe right eye visual loss of no light perception and was diagnosed with incomplete OAO. D-Dimer was elevated at 2.13 µg/ml FEU. Stroke etiological work-up found no embolic sources, resolution of the dilated cardiomyopathy and negative antiphospholipid antibodies. Treatment was changed to enoxaparin and no thrombotic events were encountered to date. Ocular vascular complications have not yet been reported in COVID-19. Controversy exists on the best management algorithm for the hypercoagulable state associated to COVID-19 Either direct oral anticoagulants or low-molecular-weight-heparin are considered appropriate at discharge for patients with venous thromboembolism. The optimum regimen for ischemic stroke prevention and the significance of D-Dimer for anticoagulation monitoring in COVID-19 remain unclear. Elsevier Inc. 2020-08 2020-05-23 /pmc/articles/PMC7245224/ /pubmed/32689586 http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104982 Text en © 2020 Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Article Dumitrascu, Oana M. Volod, Oksana Bose, Swaraj Wang, Yao Biousse, Valérie Lyden, Patrick D. Acute ophthalmic artery occlusion in a COVID-19 patient on apixaban |
title | Acute ophthalmic artery occlusion in a COVID-19 patient on apixaban |
title_full | Acute ophthalmic artery occlusion in a COVID-19 patient on apixaban |
title_fullStr | Acute ophthalmic artery occlusion in a COVID-19 patient on apixaban |
title_full_unstemmed | Acute ophthalmic artery occlusion in a COVID-19 patient on apixaban |
title_short | Acute ophthalmic artery occlusion in a COVID-19 patient on apixaban |
title_sort | acute ophthalmic artery occlusion in a covid-19 patient on apixaban |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245224/ https://www.ncbi.nlm.nih.gov/pubmed/32689586 http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.104982 |
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