{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T04:07:26Z","timestamp":1758946046976,"version":"3.44.0"},"reference-count":38,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T00:00:00Z","timestamp":1617235200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/bmj.com\/coronavirus\/usage"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,3,29]]},"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:p>Emerging evidence suggests that novel COVID-19 is associated with increased prothrombotic state and risk of thromboembolic complications, particularly in severe disease. COVID-19 is known to predispose to both venous and arterial thrombotic disease. We describe a case of a 61-year-old woman with history of type II diabetes, hypertension and hyperlipidaemia who presented with dry cough and acute abdominal pain. She was found to have a significantly elevated D-dimer, prompting imaging that showed thrombi in her right ventricle and aorta. She had rapid clinical deterioration and eventually required tissue plasminogen activator with subsequent durable clinical improvement. This case highlights a rare co-occurrence of venous and arterial thrombi in a patient with severe COVID-19. Further studies are needed to clarify the molecular mechanism of COVID-19 coagulopathy, the utility of D-dimer to predict and stratify risk of thrombosis in COVID-19, and the use of fibrinolytic therapy in patients with COVID-19.<\/jats:p>","DOI":"10.1136\/bcr-2020-240745","type":"journal-article","created":{"date-parts":[[2021,4,19]],"date-time":"2021-04-19T13:06:40Z","timestamp":1618837600000},"page":"e240745","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Case of right ventricular and aortic thrombi in a patient with severe COVID-19"],"prefix":"10.1136","volume":"14","author":[{"given":"Henrietta","family":"Afari","sequence":"first","affiliation":[{"name":"Hospital Medicine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leben","family":"Tefera","sequence":"additional","affiliation":[{"name":"Harrington Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel P","family":"Rosovsky","sequence":"additional","affiliation":[{"name":"Department of Hematology, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,4,19]]},"reference":[{"key":"2025082622481843000_14.4.e240745.1","first-page":"157","article-title":"WHO Declares COVID-19 a pandemic","volume":"91","author":"Cucinotta","year":"2020","journal-title":"Acta Biomed"},{"key":"2025082622481843000_14.4.e240745.2","unstructured":"COVID-19 Dashboard by the center for systems science and engineering (CSSE) at Johns Hopkins University (JHU). Available: https:\/\/coronavirus.jhu.edu\/map.html [Accessed 10 Aug 2020]."},{"key":"2025082622481843000_14.4.e240745.3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/1076029620948137","article-title":"COVID-19 associated coagulopathy and thrombotic complications","volume":"26","author":"Mezalek","year":"2020","journal-title":"Clinical and Applied Thrombosis\/Hemostasis"},{"key":"2025082622481843000_14.4.e240745.4","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.thromres.2020.05.039","article-title":"Thrombosis risk associated with COVID-19 infection. A scoping review","volume":"192","author":"Al-Ani","year":"2020","journal-title":"Thromb Res"},{"key":"2025082622481843000_14.4.e240745.5","doi-asserted-by":"crossref","first-page":"1578","DOI":"10.1002\/ajh.25982","article-title":"Thrombosis in COVID-19","volume":"95","author":"Hanff","year":"2020","journal-title":"Am J Hematol"},{"key":"2025082622481843000_14.4.e240745.6","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1177\/1538574420966106","article-title":"Thoracic aortic mural thrombus, right ventricular clot and pulmonary embolism in a patient with COVID-19 pneumonia","volume":"55","author":"Masana","year":"2021","journal-title":"Vasc Endovascular Surg"},{"key":"2025082622481843000_14.4.e240745.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2020.04.024"},{"key":"2025082622481843000_14.4.e240745.8","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-020-02146-z"},{"key":"2025082622481843000_14.4.e240745.9","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1093\/ehjcvp\/pvaa087","article-title":"Systemic fibrinolysis for acute pulmonary embolism complicating acute respiratory distress syndrome in severe COVID-19: a case series","volume":"7","author":"Della Bona","year":"2021","journal-title":"Eur Heart J Cardiovasc Pharmacother"},{"key":"2025082622481843000_14.4.e240745.10","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1111\/jth.14828","article-title":"Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): a case series","volume":"18","author":"Wang","year":"2020","journal-title":"J Thromb Haemost"},{"key":"2025082622481843000_14.4.e240745.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k4810"},{"key":"2025082622481843000_14.4.e240745.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2020.04.013"},{"key":"2025082622481843000_14.4.e240745.13","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1016\/j.chest.2020.11.005","article-title":"Incidence of VTE and bleeding among hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis","volume":"159","author":"Jim\u00e9nez","year":"2021","journal-title":"Chest"},{"key":"2025082622481843000_14.4.e240745.14","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1016\/j.jaccas.2020.05.034","article-title":"Right ventricular clot in transit in COVID-19: implications for the pulmonary embolism response team","volume":"2","author":"Sethi","year":"2020","journal-title":"JACC Case Rep"},{"key":"2025082622481843000_14.4.e240745.15","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.thromres.2020.05.025","article-title":"Severe arterial thrombosis associated with Covid-19 infection","volume":"192","author":"Kashi","year":"2020","journal-title":"Thromb Res"},{"key":"2025082622481843000_14.4.e240745.16","doi-asserted-by":"crossref","unstructured":"Masana M , Martinez LI , Gil M . Thoracic aortic mural thrombus, right ventricular clot and pulmonary embolism in a patient with COVID-19 pneumonia. Vasc Endovascular Surg 2020;1538574420966106.","DOI":"10.1177\/1538574420966106"},{"key":"2025082622481843000_14.4.e240745.17","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-020-03077-0"},{"key":"2025082622481843000_14.4.e240745.18","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.thromres.2020.04.035","article-title":"Arterial and venous thrombosis: what's the link? A narrative review","volume":"191","author":"Delluc","year":"2020","journal-title":"Thromb Res"},{"key":"2025082622481843000_14.4.e240745.19","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.709204"},{"key":"2025082622481843000_14.4.e240745.20","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30566-3"},{"key":"2025082622481843000_14.4.e240745.21","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2020006520"},{"key":"2025082622481843000_14.4.e240745.22","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14810"},{"key":"2025082622481843000_14.4.e240745.23","unstructured":"Rosovsky RP , Grodzin C , Channick R . Diagnosis and treatment of pulmonary embolism during the COVID-19 pandemic. A Position Paper from the National PERT Consortium. Chest 2020;27."},{"key":"2025082622481843000_14.4.e240745.24","unstructured":"National Institutes of Health . Antithrombotic therapy in patients with COVID-19 in COVID-19 treatment guidelines panel. coronavirus disease 2019 (COVID-19) treatment guidelines. Available: https:\/\/www.covid19treatmentguidelines.nih.gov\/antithrombotic-therapy\/ [Accessed 24 Feb 2021]."},{"key":"2025082622481843000_14.4.e240745.25","doi-asserted-by":"publisher","DOI":"10.1007\/s11239-020-02138-z"},{"key":"2025082622481843000_14.4.e240745.26","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1177\/1358863X16675229","article-title":"Antithrombotic therapy in aortic diseases: a narrative review","volume":"22","author":"Caron","year":"2017","journal-title":"Vasc Med"},{"key":"2025082622481843000_14.4.e240745.27","unstructured":"ClinicalTrials.gov . Dabigatran etexilate for secondary stroke prevention in patients with embolic stroke of undetermined source (RE-SPECT ESUS), identifier NCT02239120 National Library of Medicine (US); Bethesda (MD). Available: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02239120 [Accessed 24 Feb 2021]."},{"key":"2025082622481843000_14.4.e240745.28","unstructured":"ClinicalTrials.gov . Rivaroxaban versus aspirin in secondary prevention of stroke and prevention of systemic embolism in patients with recent embolic stroke of undetermined source (ESUS) (navigate ESUS), identifier NCT02313909 National Library of Medicine (US); Bethesda (MD). Available: https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02313909 [Accessed 24 Feb 2021]."},{"key":"2025082622481843000_14.4.e240745.29","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1161\/ATVBAHA.119.313137","article-title":"IL (Interleukin)-6 Contributes to Deep Vein Thrombosis and Is Negatively Regulated by miR-338-5p","volume":"40","author":"Zhang","year":"2020","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"2025082622481843000_14.4.e240745.30","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1093\/qjmed\/hcaa121","article-title":"Plasminogen improves lung lesions and hypoxemia in patients with COVID-19","volume":"113","author":"Wu","year":"2020","journal-title":"QJM"},{"key":"2025082622481843000_14.4.e240745.31","doi-asserted-by":"crossref","first-page":"2118","DOI":"10.1111\/jth.14960","article-title":"Fibrinolysis and COVID-19: a plasmin paradox","volume":"18","author":"Medcalf","year":"2020","journal-title":"J Thromb Haemost"},{"key":"2025082622481843000_14.4.e240745.32","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz405"},{"key":"2025082622481843000_14.4.e240745.33","first-page":"178","article-title":"Successful thrombolysis of right atrial and ventricular thrombi in a patient with massive pulmonary embolism","volume":"13","author":"Vogiatzis","year":"2009","journal-title":"Hippokratia"},{"key":"2025082622481843000_14.4.e240745.34","doi-asserted-by":"crossref","first-page":"146","DOI":"10.4103\/jcecho.jcecho_64_17","article-title":"Free-Floating right heart thrombus with acute massive pulmonary embolism: a case report and review of the literature","volume":"28","author":"Charif","year":"2018","journal-title":"J Cardiovasc Echogr"},{"key":"2025082622481843000_14.4.e240745.35","doi-asserted-by":"publisher","DOI":"10.1378\/chest.121.3.806"},{"key":"2025082622481843000_14.4.e240745.36","doi-asserted-by":"publisher","DOI":"10.1177\/1076029610364519"},{"key":"2025082622481843000_14.4.e240745.37","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1017\/S1047951119003093","article-title":"Spontaneous aortic thrombosis in neonates: a case report and review of literature","volume":"30","author":"Mulcaire-Jones","year":"2020","journal-title":"Cardiol Young"},{"key":"2025082622481843000_14.4.e240745.38","doi-asserted-by":"crossref","first-page":"e589","DOI":"10.1097\/MPH.0000000000001794","article-title":"Successful systemic thrombolysis in a neonatal occlusive abdominal aortic thrombus secondary to hypernatremic dehydration: a case report and literature review","volume":"42","author":"Al Nuaimi","year":"2020","journal-title":"J Pediatr Hematol Oncol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-240745","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T05:48:34Z","timestamp":1756273714000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-240745"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4]]},"references-count":38,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,19]]},"published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1136\/bcr-2020-240745"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-240745","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,4]]}}}