A Steep Rise in The Cases of Arterial Thrombosis in Post Covid Patients

There is increasing evidence of the association between COVID-19 and arterial thrombotic events as many post-Covid patients have suffered from limb and life-threatening blood clots in the arteries of the legs. The arterial thrombosis induced owing to COVID-19 infection is characterized by dire outcomes, strikingly increased rates of amputation and death. Timely follow-up, early detection of symptoms, and prompt treatment will prevent complications and the limbs can be saved from gangrene setting in and amputation.

A 46-year-old woman's Mrs S P who is a resident of Sion, Mumbai, housewife with a past medical history of hypertension, obesity was detected to be Covid positive on March 21, 2021. She had fever with cough, her Covid pneumonia CT score was 8/25 and oxygen saturation was 92%, hence was admitted to the hospital on 27th March, 2021 and needed 4 litres of oxygen She was treated with the help of steroids and Remdesivir for 6 days. She recovered well and her saturation 98% on room air with no breathlessness. The patient was discharged on day 10 on oral steroids, antibiotics, and on ecosprin in the first week of April. 9 days post-discharge, she experienced pain in the left foot. She consulted a physician who advised pain killers.  But, nothing seemed to work in her favour.  To her dismay, 24 hours later pain worsened. The physician referred her to an orthopaedic who advised her an arterial colour doppler, which revealed clots (thrombosis) in the main artery supplying the leg (the superficial femoral artery), with poor blood flow in the leg.

She presented to us with severe left leg pain, on examination the leg and foot was cold with the toes showing discolouration. We took her for an angiography as an emergency in the night, which revealed clots in the left leg arteries. With a special catheter we aspirated the clots and gave a clot busting drug to dissolve the leg clots. This drug was given for 12 hours through a catheter in the leg. We repeated an angiogram which showed near total clearance of the clots. The pain disappeared with the foot now warm to touch. The pulses in the foot were felt, and she had good toe movements.

Dr Rahul Sheth, Interventional Radiologist, Zen Multispeciality Hospital, said, “24 patients have been treated for lower limb arterial clots. We have been able to save 17 limbs, where no amputation was required. 7 patients required some form of amputation, since they presented late. Out of the 24 patients, 2 presented in the first wave, and 22 in the second wave.”

Various studies have proven that covid infection leads to clots in the arteries that are responsible for carrying oxygen-rich blood to the body from the heart, and this can be termed arterial thrombosis. it is postulated that Covid-19 increases the blood's viscosity of the blood causing clots When the blood flow in the artery is blocked due to the clots, there is no oxygen supply to the body parts. When this affects the legs it can lead to severe leg pain, cold limbs and if untreated will progress to gangrene with amputation or removal of the limb to save the patient's life. These blood clots can also travel all over the body and damage distant organs. "

Dr Sheth added,” The symptoms will be noticeable sometimes during active covid or sometimes even 7 to 10 days post covid recovery.

The golden period to treat is within 24 hours after the onset of the symptoms. Any symptoms like leg pain, pain on walking, cold limb should not be ignored and a doctor should be consulted. Examination of the affected leg and palpation of the foot pulses should be done. If the pulses are absent, then immediate admission should be done, followed by an arterial colour Doppler.

This colour doppler is like sonography for the blood vessels to detect the blockage. Then, a peripheral angiography is performed to confirm the diagnosis and decide on a treatment plan. Two main options are there; endovascular, where the clots are removed using a special catheter and a clot busting drug is given to dissolve the clots; or surgical wherein an incision is made in the artery and the clot removed using a device. Endovascular is preferred nowadays, since the clots in the small blood vessels in the leg and foot can also be cleared.

“There is no awareness regarding this condition and the patients ignore the early symptoms. Some come to the hospital in advanced stages with discoloration of skin or gangrene. The first 12 to 24 hours of symptoms are crucial blood circulation needs to be restored; ideally earlier the better. Don't take severe leg pain or any abnormal changes in the body casually, during the post-covid period,” said Dr Sheth.

“I was incapacitated due to the severe foot pain, and unable to do my daily activities with ease. I couldn’t walk, stand or even access the washroom.  I am fortunate to receive prompt treatment at Zen hospital wherein the doctors saved my limb and amputation too. I want to urge other patients like me to be careful and avoid delaying treatment. I am thankful to the doctors for giving me a new lease of life, and I have resumed my daily routine. I walk on my own and there is no leg pain now," concluded patient Mrs S P