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Labile PT-INR in a Covid-19 Patient Under Long-term Vitamin K Antagonist Therapy: a Case Report

The COronaVIrus Disease-19 (COVID-19) has been associated with thromboembolic complications, but evidence on its impact on hemorrhagic risk are still scarce. We describe a case of COVID-19 with hemorrhagic complication in the post-acute phase of the disease. The patient was a 93-year-old woman admit...

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Autores principales: Trevisan, Caterina, Miconi, Lorella, Barbierato, Emanuele, Marinaro, Giuseppe, Targhetta, Stefano, D’agata, Mario, Rinaldi, Daniela
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437640/
https://www.ncbi.nlm.nih.gov/pubmed/32839751
http://dx.doi.org/10.1007/s42399-020-00460-4
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author Trevisan, Caterina
Miconi, Lorella
Barbierato, Emanuele
Marinaro, Giuseppe
Targhetta, Stefano
D’agata, Mario
Rinaldi, Daniela
author_facet Trevisan, Caterina
Miconi, Lorella
Barbierato, Emanuele
Marinaro, Giuseppe
Targhetta, Stefano
D’agata, Mario
Rinaldi, Daniela
author_sort Trevisan, Caterina
collection PubMed
description The COronaVIrus Disease-19 (COVID-19) has been associated with thromboembolic complications, but evidence on its impact on hemorrhagic risk are still scarce. We describe a case of COVID-19 with hemorrhagic complication in the post-acute phase of the disease. The patient was a 93-year-old woman admitted to a post-acute care unit for COVID-19 patients in northern Italy. The patient’s medical history included moderate cognitive impairment, atrial fibrillation under oral anticoagulation (warfarin 2.5 mg and 3.75 mg on alternate days, showing stable PT-INR values since October 2018), and arterial hypertension. The patient was affected by COVID-19, treated with supportive therapy. In the post-acute phase of the disease, the patient presented with melena and showed a marked elevation of PT-INR of 25.1. She was treated with venous infusion of three-factor prothrombin complex concentrate and vitamin K until PT-INR reduction. After 5 days, blood analyses revealed normal hemoglobin, PT-INR 2.15, and a slight alteration of liver function. This case supports a strong impact of the infection on the coagulative pattern not only pro-thrombotically but also by increasing hemorrhagic risk. Special attention should therefore be paid to COVID-19 patients under anticoagulation with vitamin K antagonist and a shift to heparin treatment until illness resolution may be a safe option in these individuals.
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spelling pubmed-74376402020-08-20 Labile PT-INR in a Covid-19 Patient Under Long-term Vitamin K Antagonist Therapy: a Case Report Trevisan, Caterina Miconi, Lorella Barbierato, Emanuele Marinaro, Giuseppe Targhetta, Stefano D’agata, Mario Rinaldi, Daniela SN Compr Clin Med Covid-19 The COronaVIrus Disease-19 (COVID-19) has been associated with thromboembolic complications, but evidence on its impact on hemorrhagic risk are still scarce. We describe a case of COVID-19 with hemorrhagic complication in the post-acute phase of the disease. The patient was a 93-year-old woman admitted to a post-acute care unit for COVID-19 patients in northern Italy. The patient’s medical history included moderate cognitive impairment, atrial fibrillation under oral anticoagulation (warfarin 2.5 mg and 3.75 mg on alternate days, showing stable PT-INR values since October 2018), and arterial hypertension. The patient was affected by COVID-19, treated with supportive therapy. In the post-acute phase of the disease, the patient presented with melena and showed a marked elevation of PT-INR of 25.1. She was treated with venous infusion of three-factor prothrombin complex concentrate and vitamin K until PT-INR reduction. After 5 days, blood analyses revealed normal hemoglobin, PT-INR 2.15, and a slight alteration of liver function. This case supports a strong impact of the infection on the coagulative pattern not only pro-thrombotically but also by increasing hemorrhagic risk. Special attention should therefore be paid to COVID-19 patients under anticoagulation with vitamin K antagonist and a shift to heparin treatment until illness resolution may be a safe option in these individuals. Springer International Publishing 2020-08-19 2020 /pmc/articles/PMC7437640/ /pubmed/32839751 http://dx.doi.org/10.1007/s42399-020-00460-4 Text en © Springer Nature Switzerland AG 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Covid-19
Trevisan, Caterina
Miconi, Lorella
Barbierato, Emanuele
Marinaro, Giuseppe
Targhetta, Stefano
D’agata, Mario
Rinaldi, Daniela
Labile PT-INR in a Covid-19 Patient Under Long-term Vitamin K Antagonist Therapy: a Case Report
title Labile PT-INR in a Covid-19 Patient Under Long-term Vitamin K Antagonist Therapy: a Case Report
title_full Labile PT-INR in a Covid-19 Patient Under Long-term Vitamin K Antagonist Therapy: a Case Report
title_fullStr Labile PT-INR in a Covid-19 Patient Under Long-term Vitamin K Antagonist Therapy: a Case Report
title_full_unstemmed Labile PT-INR in a Covid-19 Patient Under Long-term Vitamin K Antagonist Therapy: a Case Report
title_short Labile PT-INR in a Covid-19 Patient Under Long-term Vitamin K Antagonist Therapy: a Case Report
title_sort labile pt-inr in a covid-19 patient under long-term vitamin k antagonist therapy: a case report
topic Covid-19
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437640/
https://www.ncbi.nlm.nih.gov/pubmed/32839751
http://dx.doi.org/10.1007/s42399-020-00460-4
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