“Antithrombotic treatment dilemma in COVID-19”- a case report
Nevena Ivanova
Keywords: COVID-19, GP, cardiovasclar, antithrombotic treatment
Introduction:
COVID‐19 (SARS‐CoV‐2 virus) is a novel coronavirus which emerged in Wuhan, China in December 2019 and became pandemic in March 2020. The symptoms are nonspecific and their severity can vary. Most common are fever, dry cough and tiredness. COVID‐19 mainly affects the respiratory tract from mild symptoms to bilateral pneumonia and acute respiratory distress syndrome. Due to a global inflammatory response and endothelial damage, COVID‐19 may predispose to cardiovascular thrombotic disorders and events such as stroke, myocardial infarction and peripheral artery disease.
Case:
A 83 years old male has been diagnosed for COVID-19 with PCR test. He was under home care because refused hospital treatment and had been consulted by his GP by phone. He suffered fever, headache, dry cough, shortness of breath during minimal exercise, chest discomfort and tiredness. The X-ray showed bilateral pneumonia. The patient has past history of acute anterior myocardial infarction 10 days ago and undergone emergency coronary angiography which reviled three vessel coronary artery disease-100% occlusion of left anterior descending artery in proximal segment, 70% stenosis of left circumflex artery, 80% stenosis of right coronary artery in proximal segment. The percutaneous coronary intervention included stenting of LADp with three drug eluting stents. For the period of 1 year he experienced two episodes of atrial fibrillation with pharmaceutical conversion to sinus rhythm.
Discussion:
GPs are first line doctors, so they make initial decision about diagnosis, complications, treatment and indications for hospital treatment. The distance between doctor and patient makes that hard and increases the risk of making life-threatening mistakes. Because of thrombotic predisposition in COVID-19, antithrombotic treatment plays a key role. Stenting requires double antiplatelet treatment, COVID-19 addition of anticoagulant. In elderly patients it increases the risk of bleeding. The GP has to balance risk and benefits.
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