Introduction:
SARS-Coronavirus-2
infection leading to COVID-19 disease presents most often with
respiratory failure. The systemic inflammatory response of SARS-CoV-2
along with the hypercoagulable state that the infection elicits can lead
to acute thrombotic complications including ischemic stroke. We present
3 cases of patients with COVID-19 disease who presented with varying
degrees of vascular thrombosis.
Cases:
Cases
1 and 2 presented as cerebral ischemic strokes without respiratory
failure. Given their exposure risks, they were both tested for COVID-19
disease. Case 2 ultimately developed respiratory failure and pulmonary
embolism. Cases 2 and 3 were found to have simultaneous arterial and
venous thromboembolism (ischemic stroke and pulmonary embolism) as well
as positive antiphospholipid antibodies.
Conclusion:
Our
case series highlight the presence of hypercoagulability as an
important mechanism in patients with COVID-19 disease with and without
respiratory failure. Despite arterial and venous thromboembolic events,
antiphospholipid and hypercoagulable panels in the acute phase can be
difficult to interpret in the context of acute phase response and
utilization of thrombolytics. SARS-CoV-2 testing in patients presenting
with stroke symptoms may be useful in communities with a high case
burden or patients with a history of exposure.
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