tibljТуберкулез и болезни легкихTuberculosis and Lung Diseases2075-12302542-1506Медицинские знания и технологии10.21292/2075-1230-2022-100-4-22-25tiblj-1629Research ArticleCOVID-19COVID-19Сочетание артериального и венозного тромбоза у пациента с новой коронавирусной инфекцией (клинический случай)Combination of arterial and venous thrombosis in a patient with the novel coronavirus infection (a clinical case)БайгозинаЕ. А.BaygozinaE. А.

Байгозина Евгения Александровна, профессор кафедры госпитальной терапии, эндокринологии

644099, г. Омск, ул. Ленина, д. 12

Тел.: 8 (3812) 35-93-68

Evgeniya A. Baygozina, Head of Hospital Therapy and Endocrinology Department

12, Lenina St., Omsk, 644099

Phone: +7 (3812) 35-93-68

intdis-1@rambler.ruФГБОУ ВО «Омский государственный медицинский университет» МЗ РФРоссияOmsk State Medical UniversityRussian Federation20221405202210042225Copyright © Байгозина Е.А., 20222022Байгозина Е.А.Baygozina E.А.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.tibl-journal.com/jour/article/view/1629

В представленном клиническом наблюдении продемонстрировано достаточно редкое сочетание артериального и венозного тромбоза у пациента с тяжелой формой коронавирусной инфекции COVID-19 с летальным исходом. Клиническими проявлениями тромбозов стали острая необратимая ишемия нижних конечностей, острое нарушение мозгового кровообращения и венозный тромбоз левой нижней конечности. Причиной данных тромботических осложнений явилась вирус-индуцированная коагулопатия при наличии факторов риска: старческий возраст, сопутствующие заболевания и отсроченное назначение антикоагулянтов. Механизмы развития тромботических осложнений у пациентов с COVID-19 достаточно сложны и нуждаются в дальнейшем изучении.

The presented clinical case demonstrates a rare combination of arterial and venous thrombosis in a patient with severe COVID-19 coronavirus infection and a fatal outcome. The clinical manifestations of thrombosis were acute irreversible ischemia of the lower extremities, acute impairment of cerebral circulation, and venous thrombosis of the left lower extremity. These thrombotic complications were caused by virus-induced coagulopathy deteriorated by such risk factors as an old age, comorbidities and delayed prescription of anticoagulants. The mechanisms of thrombotic complications in patients with COVID-19 are complex and require further investigation.

COVID-19вирус-индуцированная коагулопатияартериальный и венозный тромбозCOVID-19virus-induced coagulopathyarterial and venous thrombosisReferencesСироткина О. В., Ермаков А. И., Гайковая Л. Б., Кудлай Д. А., Вавилова Т. В. Микрочастицы клеток крови у больных COVID-19 как маркер активации системы гемостаза // Тромбоз, гемостаз и реология. ‒ 2020. ‒ Т. 82, № 4. ‒ С. 35-40.Sirotkina O.V., Ermakov A.I., Gaykovaya L.B., Kudlay D.A., Vavilova T.V. Microparticles of blood cells in patients with COVID-19 as a marker of the hemostasis system activation. Tromboz, Gemostaz I Reologiya, 2020, vol. 82, no. 4, pp. 35-40. (In Russ.)Amaravathi U., Balamurugan N., Pillai V. M. et al. Superior mesenteric arterial and venous thrombosis in COVID-19 // J. Emerg. Med. ‒ 2021. ‒ Vol. 60, № 5. ‒ P. e103-e107.Amaravathi U., Balamurugan N., Pillai V.M. et al. Superior mesenteric arterial and venous thrombosis in COVID-19. J. Emerg. Med., 2021, vol. 60, no. 5, pp. e103-e107.Connors J., Levy J. COVID-19 and its implications for thrombosis and anticoagulation // Blood. ‒ 2020. ‒ № 135. ‒ P. 2033-2040. https: doi.org/10.1182/blood.2020006000.Connors J., Levy J. COVID-19 and its implications for thrombosis and anticoagulation. Blood, 2020, no. 135, pp. 2033-2040. https: doi.org/10.1182/blood.2020006000.Gomez-Mesa J. E., Galindo-Coral S., Montes M. C. et al. Trombosis and Coagulopathy in COVID-19 // Curr. Probl. Cardiol. ‒ 2021. ‒ № 46. ‒ Р. 100742. https : // doi.org/10.1016/j.cardiol.2020.10074.Gomez-Mesa J.E., Galindo-Coral S., Montes M.C. et al. Trombosis and Coagulopathy in COVID-19. Curr. Probl. Cardiol., 2021, no. 46, pp. 100742. https:doi.org/10.1016/j.cardiol.2020.10074.Gralinski L. E., Bankhead A., Jeng S. et al. Mechanisms of severe acute respiratory syndrome coronavirus-induced acute lung injury // mBio. ‒ 2013. ‒ № 4. ‒ Р. e00271-13.Gralinski L.E., Bankhead A., Jeng S. et al. Mechanisms of severe acute respiratory syndrome coronavirus-induced acute lung injury. mBio, 2013, no. 4, pp. e00271-13.Gupta N., Zhao Y. Y., Evans C. E. The stimulation of thrombosis by hypoxia // Thromb. Res. ‒ 2019. ‒ № 181. ‒ P. 77-83.Gupta N., Zhao Y.Y., Evans C.E. The stimulation of thrombosis by hypoxia. Thromb. Res., 2019, no. 181, pp. 77-83.Kipshidze N., Dangas G., White C. J. et al. Viral coagulopathy in patients with COVID-19: treatment and care clinical and applied thrombosis // Hemostasis. ‒ 2020. ‒ Vol. 26. ‒ P. 1-7.Kipshidze N., Dangas G., White C.J. et al. Viral coagulopathy in patients with COVID-19: treatment and care clinical and applied thrombosis. Hemostasis, 2020, vol. 26, pp. 1-7.Le Berre A., Marteau V., Emmerich J. et al. Concomitant acute aortic thrombosis and pulmonary embolism complicating COVID-19 pneumonia // Diagn. Intervent. Imag. ‒ 2020. ‒ № 101. ‒ P. 321-322.Le Berre A., Marteau V., Emmerich J. et al. Concomitant acute aortic thrombosis and pulmonary embolism complicating COVID-19 pneumonia. Diagn. Intervent. Imag., 2020, no. 101, pp. 321-322.Levi M., Thachil J., Iba T. et al. Coagulation abnormalities and thrombosis in patients with COVID-19 // Lancet Haematol. ‒ 2020. ‒ № 7. ‒ P. e438-е440. https://doi.org/10/1016/S2352-3026(20)30145-9.Levi M., Thachil J., Iba T. et al. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol., 2020, no. 7, pp. e438-е440. https://doi.org/10/1016/S2352-3026(20)30145-9.Malas M. B. et al. Tromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: a systematic review and meta-analysis // Lancet. ‒ 2020. ‒ doi: 0.1016/j.eclinm.2020.100639.Epub2020Nov20.Malas M.B. et al. Tromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: a systematic review and meta-analysis. Lancet, 2020, doi:0.1016/j.eclinm.2020.100639.Epub2020Nov20.Ranucci M., Ballotta A., Di Dedda U. et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome // J. Thromb. Haemost. ‒ 2020. ‒ № 18. ‒ P. 1747-1751.Ranucci M., Ballotta A., Di Dedda U. et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J. Thromb. Haemost., 2020, no. 18, pp. 1747-1751.Varga Z., Flammer A. J., Steiger P. et al. Endothelial cell infection and endotheliitis in COVID-19 // Lancet. ‒ 2020. ‒ № 395. ‒ P. 1417-1418.Varga Z., Flammer A.J., Steiger P. et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet, 2020, no. 395, pp. 1417-1418.WHO coronavirus (COVID-19) dashboard. Gegeva: World Health Organization, 2022 (https://covid19.who.int).WHO coronavirus (COVID-19) dashboard. Gegeva: World Health Organization, 2022 (https://covid19.who.int).Zhou F., Yu T., Du R. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study // Lancet. ‒ 2020. ‒ № 395. ‒ P. 1054-1062.Zhou F., Yu T., Du R. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 2020, no. 395, pp. 1054-1062.

The authors declare that there are no conflicts of interest present.