Prothrombotic state and thrombotic events in COVID-19 pandemic period, including portal vein and splenic artery thromboses

Abstract

This editorial article is intended to perform a discussion on the manuscript entitled “Simultaneous portal vein thrombosis and splenic vein thrombosis in a COVID-19 patient: A case report and review of literature” written by Abramowitz et al. The article focuses on the diagnostic processes in a 77-year-old-male patient with a simultaneous portal vein and splenic artery thrombosis accompanying coronavirus disease 2019 (COVID-19). The authors postulated that splanchnic thrombosis should be on the list of differential diagnoses in a patient presenting with abdominal pain in presence of a COVID-19 infection. The tendency for venous and arterial thrombosis in COVID-19 patients is encountered, largely attributed to hypercoagulopathy. In general, venous thromboembolism mostly manifest as deep vein thrombosis (DVT), pulmonary embolism (PE) or catheter-related thromboembolic events. Acute PE, DVT, cerebrovascular events and myocardial infarction are seen as the most common thromboembolic complications in COVID-19 patients. COVID-19-associated hemostatic abnormalities include mild thrombocytopenia and increased D-dimer level. Similar to other coagulopathies, the treatment of the underlying condition is the mainstay. Addition of antiplatelet agents can be considered in critically ill patients at low bleeding risk, not on therapeutic anticoagulation, and receiving gastric acid suppression Early administration of antithrombotic drugs will have a beneficial effect in both the prevention and treatment of thrombotic events, especially in non-ambulatory patients. Low molecular weight heparin (LMWH) should be started if there is no contraindication, including in non-critical patients who are at risk of hospitalization LMWH (enoxaparin) is preferred to standard heparin.

Keywords: Prothrombotic state; Thrombotic events; COVID-19; Pandemic; Thromboembolism

Core Tip: Venous thromboembolisms constitute a common complication of coronavirus disease 2019 (COVID-19) and mostly manifest as deep venous thromboses, pulmonary embolism, myocardial infarction or catheter-related thromboembolic events. On the other hand, portal vein and splenic artery thromboses are rarely encountered. Since the portal vein forms the confluence of the splenic and superior mesenteric veins, portal vein thrombosis may extend to the splenic or superior mesenteric veins. Prophylactic dose anticoagulation is associated with favorable efficacy and safety in those with COVID-19, including portal vein and splenic artery thromboses.