Arterial thrombosis: the obscure threat in COVID-19 pandemic victims

INTRODUCTION: SARS-CoV-2 is a novel Coronavirus responsible for the current global pandemic resulting in an escalating number of cases and fatalities worldwide. There is a growing number of reports regarding patients presenting with acute limb ischemia due to thrombosis of all arterial beds. We conducted a literature review to identify and summarize the available data regarding the incidence of COVID-19 induced acute peripheral arterial thrombosis, potential pathophysiological mechanisms, clinical representation, diagnosis, surgical outcomes and limb salvage results. EVIDENCE ACQUISITION: References for this review were identified through searches on PubMed, Ovid Medline, and Embase from December 1, 2019 to March 15, 2021 using relevant terms related to COVID-19. Reference lists of the articles were also searched. Thirty-six publications were deemed relevant for the purpose of this literature review. EVIDENCE SYNTHESIS: An aggressive and timely medical therapy and surgical interventions should be performed to obtain positive treatment outcomes. Nevertheless, the absence of evidence-based protocols remains an obstacle for healthcare providers. Further quality research about SARS-CoV-2 infection with a focus on arterial thrombotic complications are needed to characterize arterial consequences of Coronavirus and to evaluate the necessity of therapeutic anticoagulation in COVID-19 patients with peripheral arterial occlusive disease or thrombophilia. CONCLUSIONS: Healthcare providers should be aware of the manifestations of COVID-19 and a high index of suspicion should be maintained so that all can benefit from evidence of measures that have been found to be effective. Although previous reports also identified COVID-19 patients with limb ischemia, there is limited data on the clinical course and treatment.