Right atrial thrombus in a patient with COVID-19 pneumonia:
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Significant coagulopathy and hyperinflammation are found in patients with COVID-19. Expert consensus has recommended prophylactic anticoagulation in COVID-19 patients due to the risk of thrombo-embolism. However, the use of therapeutic anticoagulation in these patients is still a matter of debate.

Authors describe a patient with COVID-19 pneumonia and a clinical hyperinflammatory state. He developed early respiratory depression and required ventilation, and he subsequently developed haemodynamic instability. Point-of-care echocardiography demonstrated a right atrial thrombus and right ventricular dysfunction suggestive of acute massive pulmonary embolism. He was managed with veno-arterial extracorporeal membrane oxygenation and local thrombolysis.

Critical cases of COVID-19 pneumonia are associated with hypercoagulation, and these patients should be monitored closely for complications. Therapeutic anticoagulation may play a role in the management and prevention of thrombo-embolism.

Learning points:

- Severe cases of COVID-2019 pneumonia are associated with hypercoagulation, and these patients should be monitored closely for complications.

- Full-dose anticoagulant therapy should be considered in severe COVID-19 pneumonia patients.

- VA-ECMO is a vital adjunct therapy in massive pulmonary embolism.

Source: https://academic.oup.com/ehjcr/article/4/FI1/1/5901690?rss=1
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