Anticoagulation in the obese patient with COVID-19-associated venous thromboembolism.

BMJ Case Reports
John Peter McCormickNiamh McDonnell

Abstract

A 61-year-old obese man who had recently tested positive for COVID-19 presented to the emergency department following an unwitnessed collapse, with a brief period of unresponsiveness. CT pulmonary angiography confirmed the presence of extensive bilateral pulmonary embolism despite the patient reporting full compliance with long-term dabigatran. The patient was initially anticoagulated with low-molecular-weight heparin and was treated with non-invasive ventilation and dexamethasone for COVID-19 pneumonia. He made a full recovery and was discharged on oral rivaroxaban. His case highlighted some of the common problems encountered when selecting an anticoagulation strategy for obese patients, as well as the lack of definitive evidence to guide treatment decisions. These challenges were further complicated by our incomplete understanding of the underlying mechanisms of COVID-19 coagulopathy, with limited data available regarding the optimal management of thromboembolic complications.

References

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Dec 14, 2019·Pharmacotherapy·Kazuhiko KidoMichael P Gulseth
Apr 3, 2020·Journal of Thrombosis and Haemostasis : JTH·Jecko Thachil
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Jun 20, 2020·Current Cardiology Reports·Juan Simon Rico-MesaRobert Chilton
Oct 1, 2020·Current Problems in Cardiology·Mohammad Kermani-Alghoraishi, Rahil Ghahramani

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