Pulmonary thromboembolism and pericardial effusion as cardiovascular complications of COVID-19 infection

Systemic activation of coagulation and pulmonary thrombo-inflammation with local vascular damage caused by SARS-CoV-2 infection increases the risk of developing thromboembolic complications: stroke, pulmonary arterial thrombosis (pulmonary thromboembolism) and deep vein thrombosis. Myopericarditis may occurs in COVID-19 patients as part of or after the onset of respiratory symptoms. Minor pericardial effusions up to 1 cm that accompany pericardial involvement are common. In our patient during hospitalization due to bilateral pneumonia caused by SARS-Cov-2 virus during a routine control of D-dimer, elevated values 2.3 fold higher than the reference range were observed, with elevated biomarkers of inflammation. She had symptoms of a respiratory infection and no pronounced clinical symptoms that would indicate pulmonary thromboembolism. MSCT pulmonary angiography was performed and low-risk thromboembolism was confirmed. Anticoagulant therapy was started - therapeutic doses of low molecular weight heparin (enoxaparin), which was extended after discharge from the hospital with DOAC (Rivaroxaban) according to the protocol for the treatment of pulmonary thromboembolism. At the control examination after 3 weeks, pericarditis with moderate pericardial effusion was determined. Anticoagulant therapy (DOAC) was extended with the inclusion of colchicine in the therapy according to the protocol for the treatment of pericarditis with effusion. After 3 months of hospitalization in our patient with mild respiratory symptoms, bronchopneumonia of the right lung developed with slightly elevated biomarkers of inflammation and normal values of D-dimer. With prescribed antibiotic therapy and current therapy (DOAC and colchicine), there was a withdrawal of symptoms and regression of pericardial effusion and a reduction in right ventricular overload. At the follow-up examination 5 months after hospitalization, complete regression of pericardial effusion was confirmed with normal biomarkers of inflammation and D-dimer values. It is advisable to exclude anticoagulant therapy (DOAC) with continued low-dose aspirin therapy.