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01 April 2021: Articles

Thromboelastography-Guided Anticoagulant Therapy for the Double Hazard of Thrombohemorrhagic Events in COVID-19: A Report of 3 Cases

Unusual clinical course, Unusual or unexpected effect of treatment

Connor M. Bunch A , Anthony V. Thomas B , John E. Stillson A , Laura Gillespie A , Kevin P. Lin D , Jacob Speybroeck A , Hau C. Kwaan D , Daniel H. Fulkerson D , Mahmud Zamlut B , Rashid Khan A , Mark M. Walsh A*

DOI: 10.12659/AJCR.931080

Am J Case Rep 2021; 22:e931080

Figure 3. Case 3: A 43-year-old woman with no past medical history was admitted with COVID-19 pneumonia, bilateral pulmonary emboli, and acute-onset idiopathic thrombocytopenic purpura. (A) Seven days after admission, the patient developed thrombi despite thromboelastography (TEG) depicting a nearly flat line tracing (dashed line). Two weeks later, the anticoagulant dose was increased after enlargement of venous thrombi, pushing her TEG tracing to a complete flat line (solid line). (B) Seven days after admission, computed tomography of the abdomen and pelvis in coronal view showed thrombosis within the entirety of the left renal vein and the inferior vena cava, both above and below the level of the renal veins. (C) Computed tomography 11 days later revealed enlargement of lower inferior vena cava and iliac thrombi.

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923