SP10.1.8 Thrombotic syndrome in COVID-19

Aim To discuss the varied manifestations of COVID-19 thrombotic syndrome. Methods We reviewed all patients referred to vascular surgery with evidence of thrombosis in at least one vascular bed. Electronic patient records were reviewed, patient laboratory and radiological investigations analysed, and COVID-19 status confirmed. Results 72 patients presented over 8 weeks with systemic thrombosis involving all sized vessels from aorta to visceral to crural arteries. Of these, 15 patients had RT-PCR or radiological evidence of COVID-19 infection. We investigated these 15 patients further. 27% presented with symptoms of thrombosis as the initial presentation of COVID-19 infection. 93% were COVID RT-PCR positive. 7% had evidence of COVID pneumonitis on CT chest but were COVID RT-PCR negative. 47% presented to the Emergency Department, whilst 53% were hospital admitted patients. All patients presented with ischaemic effects and D-dimers were raised in all patients in whom it was performed. 33% were lymphopenic. Fibrinogen levels and hypercoagulability profile was not routinely done for all and where available was negative. Echocardiogram demonstrated normal left ventricular systolic function and no evidence of thrombus in all patients in whom it was performed. 13% were managed with surgery and 6% with thrombolysis or other endovascular intervention. 73% were managed with anti-coagulation alone. 33% died during hospitalisation of COVID-19. Conclusion There is evidence that COVID-19 initiates an immuno-thrombotic state. Anti-coagulation alone was the preferred management strategy, as governed by patient co-morbidities. There is high mortality associated with patients with thrombosis and COVID-19 infection.