Case of the day

Deep Vein Thrombosis

Case of DVT. DVT -post Covid pneumonitis with polymyositis Chief Complaints . A 38 yr old female attended MOpd with left lower limbs swelling since 20 days,along with Dizziness. Calf ms are tender on palpation and swollen. No associated fever,chest pain,SOB,LOC,limb weakness or slurring of speech. No H/O HTN,DM,Thyroid Disorder or Substance Abuse. She is a K/C/O Polymyositis on Steroid. H/O of Covid Pneumonitis with chest xray showing Right lower zone non homogeneous opacity ,raised ESR of 102,positive CRP ,Covid RAT and RTPCR Neg. No H/O cancer,recent OT,OCP drug use or recent non ambulation. Normal Menstrual cycle. O/E pt is C/A/C Vitals stable. Normal General Examination except left lower limb swelling and diffuse cellulitic changes over it. Rest Systemic Examination including Neurological Examination are normal. Pt was advised D-dimer and doppler study of left lower limbs. Reports show raised D-dimer of 3970 and color doppler study showing echogenic thrombus in left external Iliac vein,superficial femoral vein,popliteal vein with very minimal flow,patchy flow in left common Iliac vein and post tibial and peroneal vein. Left saphenofemoral junction is thrombosed with no flow in great Saphenous vein. Pt was admitted and started on Antibiotics and anti coagulant. Rest ix like CT thorax and other Ix are awaited. PT/INR is 1.56.



Pt has an episode of covid which in itself is inflammatory viral disease as we know inflammatory markers are raised as in this case too Positive crp esr raised with manyfolds increase in D-dimer just enough to cause thromboembolism Here in this case we see extensive thromboembolism of lt LL at saphenofemoral junction common iliac vein and other veins of limb are thrombosed hence painful and swollened So pt needs aggrasive thrombolisation with inj enoxiparum or inj clexan Oral anticoagulants And followed by implant of filter Take help of vascular surgeon

Thanx dr Ashutosh Chandan Dubey

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Venous thrombosis is common complication of Covid 19. SARS Cov 2 virus enters through ACE 2 receptors. ACE 2 receptors are located on endothelium of veins, SARS Cov 2 virus enters the ACE 2 receptors located on endothelium and causes extensive damage. Therefore, deep vein thrombosis associated with Covid 19 is extensive and many times it can be fatal. Adv Agressive treatment is required. Start with intravenous infusion of unfractionated heparin and target aPTT value of more than 2 times of normal range Consider this case as active cases of Covid 19. Agressive treatment of underlining Covid 19 is required. Insulin is most important part of treatment of Covid 19 Following treatment can be given Covid 19 Capsule Doxy 100 mg one capsule twice a day for 7 days Tablet Azee 500 mg One tablet daily for 7 days Tablet Ecosprin 75 mg one tablet daily for 30 days Tablet Ivermectin 12 mg One tablet twice a day for 5 days Tablet Montair LC once a day for 7 days (Levocetrizine Montelukast combination) Tablet Rosuvastatin 5 mg once daily Tablet Celin/ Tablet Limcee 500 mg once daily for 30 days Paracetamol for fever as and when needed Glargine insulin injection 4 units per day Glargine insulin Brand name - Lantus insulin also called as Solostar injection (Brand Name Solostar) 32 number needle to be attached to syringe 4 units to be taken every day once a day for 10 days It is to be taken at same time every day, it can be taken at any time, time need to be same every day Kindly go through my article on role of insulin in treatment of Covid 19

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Start inj heparin 6500 units iv stat then infusion

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