Trombólise de embolia pulmonar aguda tardia pós-covid-19
DOI:
https://doi.org/10.11606/issn.2176-7262.rmrp.2022.189641Palavras-chave:
COVID-19, SARS-CoV-2, Embolia pulmonar, Trombolise, AlteplaseResumo
A embolia pulmonar (EP) tardia na COVID-19 é aquela que ocorre semanas após a infecção pelo SARS-CoV-2 e vem sendo relatada mesmo nos pacientes que manifestaram síndrome gripal leve. Não há explicação fiável para sua ocorrência, mas parece envolver persistência das alterações inflamatórias virais associadas à exposição de fosfolipídios e liberação de micropartículas de membrana potencialmente trombogênicas. A trombólise com ativadores de plasminogênio, principalmente a alteplase, é bem estabelecida nos casos de EP de alto risco e considerada nos eventos de intermediário alto risco, com benefícios como reperfusão pulmonar, redução de pressão da artéria pulmonar e estabilidade do ventrículo direito (VD). Entretanto, há poucos casos relatados de trombólise na EP secundária a COVID-19. Apresentamos o caso de uma paciente feminina adulta, sem fatores de risco significativos para eventos trombogênicos diagnosticada com COVID-19 leve que no 18º dia após o início dos sintomas evoluiu com EP associada à instabilidade de VD e foi submetida à trombólise com alteplase intravenosa com sucesso.
Downloads
Referências
Gąsecka A, Borovac JA, Guerreiro RA, Giustozzi M, Parker W, Caldeira D, et al. Thrombotic Complications in Patients with COVID-19: Pathophysiological Mechanisms, Diagnosis, and Treatment [Internet]. Vol. 35, Cardiovascular Drugs and Therapy. Springer; 2021 [cited 2021 Apr 26]. p. 215–29. Available from: https://pubmed.ncbi.nlm.nih.gov/33074525/
Kipshidze N, Dangas G, White CJ, Kipshidze N, Siddiqui F, Lattimer CR, et al. Viral Coagulopathy in Patients With COVID-19: Treatment and Care. Vol. 26, Clinical and Applied Thrombosis/Hemostasis. SAGE Publications Inc.; 2020.
Luiz Cicilini A, Ferreira de Oliveira A, Murilo Trovo Hidalgo Filho C, Freitas Nogueira Salles R, Higa Fróes M, de Medeiros Eduardo J. Clinical case: secondary pulmonary embolism in a patient with COVID-19. Medicina (Ribeirao Preto). 2020 Oct 14;53(3):313–20.
Long B, Brady WJ, Koyfman A, Gottlieb M. Cardiovascular complications in COVID-19. Vol. 38, American Journal of Emergency Medicine. W.B. Saunders; 2020. p. 1504–7.
Vechi HT, Maia LR, Alves MDM. Late acute pulmonary embolism after mild coronavirus disease 2019 (COVID-19): A case series. Revista do Instituto de Medicina Tropical de Sao Paulo. 2020;62:1–9.
Taha M, Nguyen P, Sharma A, Taha M, Samavati L. Forty-One-Year-Old Man with Pulmonary Embolism 5 Months After COVID-19. Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine. 2021;15.
Beckman M, Nyrén S, Kistner A. A case-report of widespread pulmonary embolism in a middle-aged male seven weeks after asymptomatic suspected COVID 19 infection. Thrombosis Journal. 2020 Aug 28;18(1):19.
Kanso M, Cardi T, Marzak H, Schatz A, Faucher L, Grunebaum L, et al. Delayed pulmonary embolism after COVID-19 pneumonia: a case report. Timothy C T, Rafael VP, Sylvia K, Max S, Vassilios Parisis M, editors. European Heart Journal - Case Reports. 2020 Dec 1;4(6):1–4.
Konstantinides S V., Meyer G, Bueno H, Galié N, Gibbs JSR, Ageno W, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS). Vol. 41, European Heart Journal. Poland; 2020. p. 543–603.
Alharthy A, Faqihi F, Papanikolaou J, Balhamar A, Blaivas M, Memish ZA, et al. Thrombolysis in severe COVID-19 pneumonia with massive pulmonary embolism. American Journal of Emergency Medicine. 2021 Mar 1;41:261.e1-261.e3.
Ucar EY. Update on thrombolytic therapy in acute pulmonary thromboembolism. Vol. 51, Eurasian Journal of Medicine. AVES; 2019. p. 185–9.
Arachchillage DJ, Stacey A, Akor F, Scotz M, Laffan M. Thrombolysis restores perfusion in COVID-19 hypoxia. Vol. 190, British Journal of Haematology. Blackwell Publishing Ltd; 2020. p. e270–4.
Wang J, Hajizadeh N, Moore EE, McIntyre RC, Moore PK, Veress LA, et al. Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): A case series. Journal of Thrombosis and Haemostasis. 2020 Jul 1;18(7):1752–5.
Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, et al. CT imaging features of 2019 novel coronavirus (2019-NCoV). Radiology. 2020 Feb 4;295(1):202–7.
Salam S, Mallat J, Elkambergy H. Acute high-risk pulmonary embolism requiring thrombolytic therapy in a COVID-19 pneumonia patient despite intermediate dosing deep vein thromboprophylaxis. Respiratory Medicine Case Reports. 2020 Jan 1;31:101263.
Connors JM. Thrombophilia Testing and Venous Thrombosis. New England Journal of Medicine [Internet]. 2017 Sep 21 [cited 2022 Apr 14];377(12):1177–87. Available from: https://www.nejm.org/doi/pdf/10.1056/NEJMra1700365
Zhang Y, Xiao M, Zhang S, Xia P, Cao W, Jiang W, et al. Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19. N Engl J Med [Internet]. 2020 [cited 2020 Apr 19]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/32268022
Zhang L, Wang B, Zhou J, Kirkpatrick J, Xie M, Johri AM. Bedside Focused Cardiac Ultrasound in COVID-19 from the Wuhan Epicenter: The Role of Cardiac Point-of-Care Ultrasound, Limited Transthoracic Echocardiography, and Critical Care Echocardiography. Journal of the American Society of Echocardiography. 2020 Jun 1;33(6):676–82.
Squizzato A, Galli L, Gerdes VEA. Point-of-care ultrasound in the diagnosis of pulmonary embolism. Vol. 7, Critical Ultrasound Journal. Springer-Verlag Italia s.r.l.; 2015.
Ortel TL, Neumann I, Ageno W, Beyth R, Clark NP, Cuker A, et al. American society of hematology 2020 guidelines for management of venous thromboembolism: Treatment of deep vein thrombosis and pulmonary embolism. Vol. 4, Blood Advances. American Society of Hematology; 2020. p. 4693–738.
Thachil J. The versatile heparin in COVID‐19. Journal of Thrombosis and Haemostasis. 2020 May 27;18(5):1020–2.
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2022 André Luiz Cicilini, Lucas Kajihara, Michele Higa Fróes, Jamilton de Medeiros Eduardo
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
