Successful Systemic Lysis Therapy of a Floating Carotid Thrombus in an Acute Stroke Patient with Known Immune Thrombocytopenia (ITP) on Ongoing Eltrombopag Therapy and Acute COVID-19 Infection: a Case Report.

Autor: Adam LC; Department of Neurology, Vivantes Klinikum Spandau, Berlin, Germany.; Department of Neurology and Experimental Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany., Burgstaller M; Department of Neurology, Vivantes Klinikum Spandau, Berlin, Germany., Taetweiler U; Department of Hematology, Vivantes Klinikum Spandau, Berlin, Germany., Mueller J; Department of Neurology, Vivantes Klinikum Spandau, Berlin, Germany.
Jazyk: angličtina
Zdroj: SN comprehensive clinical medicine [SN Compr Clin Med] 2023; Vol. 5 (1), pp. 133. Date of Electronic Publication: 2023 Apr 28.
DOI: 10.1007/s42399-023-01465-5
Abstrakt: Patients with immune thrombocytopenia (ITP) under eltrombopag therapy are vulnerable to thrombotic disbalance, both due to the disease itself and therapy-related hypercoagulability. Vascular events such as the development of a free-floating carotid thrombus are known rare complications of acute COVID-19 infections due to endothelial inflammation and presumptive underlying hypercoagulable state. In patients at risk, the onset of new focal neurological symptoms should prompt immediate angiographic diagnostics and, if necessary, appropriate treatment. Here, we report a case of a 38-year-old female with a medical history of ITP and the presence of COVID-19 infection presenting an acute sensorimotor hemiparesis of the right side while on eltrombopag therapy. Initial CT angiography revealed a free-floating thrombus in the left common carotid artery. Upon admission, the patient's platelet count was significantly elevated at 896 × 10 9 /l. After systemic lysis therapy, the thrombus was fully dissolved. Follow-up diffusion-weighted imaging revealed multilocular cortical infarction of the left MCA territory. The patient soon recovered and was discharged with residual mild sensorimotor deficits in the right arm. Eltrombopag was paused at admission, and the patient's platelet count was quickly returning to normal. She was discharged with a daily intake of acetylsalicylic acid, a reduced daily dose of eltrombopag, and weekly monitoring of her platelet count for the next three months. This unique case highlights the need for caution in patients at vascular risk who contract COVID-19 and discusses thrombocytic derailment under thrombopoietin receptor agonist therapy in the context of an acute COVID-19 infection.
Competing Interests: Conflict of InterestThe authors declare no competing interests.
(© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)
Databáze: MEDLINE
Externí odkaz: