Stent thrombosis may be more common in COVID-19 patients

Be careful out there. While this suggests waiting for further study on antiplatelet regimens, I'm going to demand immediate use of them, even though I have no stents to be concerned about. But I'm not medically trained so don't listen to me. 

Stent thrombosis may be more common in COVID-19 patients

Reuters Health Medical News|June 11, 2020

Stent thrombosis appears to be more common in patients with COVID-19, according to a case series.

"We don't want to create alarm," Dr. Juan G. Cordoba-Soriano of Complejo Hospitalario Universitario de Albacete, in Albacete, Spain, told Reuters Health by email. "In general, the risk is low, we think. In our center we had nearly 2,000 COVID-19 patients and only 4 stent thromboses (ST), but it is certain that it is a higher incidence than expected among percutaneous coronary intervention (PCI) procedures."

"During the peak of the pandemic at our center, we had the subjective feeling that presentation of patients with ST was higher than expected compared with our experience in normal conditions," he said. "Some other interventional cardiologists in Spain had the same feeling."

Dr. Cordoba-Soriano and colleagues describe four cases of coronary stent thrombosis between March 15 and April 5 at their center in a paper in JACC Case Reports.

The patients included a 49-year-old man who underwent primary angioplasty for a lateral ST-elevation myocardial infarction (STEMI), a 71-year-old man whose stent was placed following an inferior STEMI in 2007, an 86-year-old man whose stent was placed following a non-ST-elevation MI in 2018, and an 85-year-old man whose stent was placed in 2005.

Two patients had a cough and chest x-ray findings compatible with COVID-19, but confirmatory tests were not performed at the early stage of the pandemic. One of these patients later tested positive for IgG to SARS-CoV-2; the other was not tested. The third patient tested positive for SARS-CoV-2 RNA, and the fourth patient tested positive for IgM to SARS-CoV-2.

These four incidents represented 13% of PCIs performed during this period, compared with an overall incidence of ST of 1.2% during 2019.

"This virus is highly thrombogenic," Dr. Cordoba-Soriano said. "As we have learnt that anticoagulation is key in the management of these patients, it is important to treat them with the currently available support of the guidelines and according to their recommendations when they present with an acute coronary syndrome."

He endorsed the careful use of antiplatelet regimens in these patients, pending further study.

"We decided to perform a multicenter registry, which we hope will be published soon by another colleague," Dr. Cordoba-Soriano added.

—Will Boggs MD

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