Analysis of COVID-19 complicated vascular cases from General Practice perspective

Lyubima Despotova-Toleva, Bogomila Cheshmedzhieva

Keywords: COVID-19, COVID-19 associated coagulopathy, thrombophlebitis, embolism and arterial thrombosis, psychosis

To date, sufficient evidence has been accumulated on the link between COVID-19 and a vast spectrum of vascular pathology, incl. vascular inflammation and the development of coagulopathies, which can lead to thrombocytopenia, hypercoagulation and thrombosis, as well as bleeding. These pathological changes themselves can not only lead to respiratory and oxygenation disorders, further aggravate the patient's respiratory status, but also to a number of other complications (neurological, psychosis etc.). In the early recognition of these conditions GPs could play a very important role.

Research questions:
In what extent analyzing complicated cases contributes to better understanding by GPs of the complex pathology and timely referral of COVID-19 patients for specialized treatment?

Ongoing study on COVID-19 patients with combined COVID-19 infection (incl. typical pulmonary involvement) and vascular pathology; analysis of cases; teaching GPs with cases

Several cases of patients with COVID-19 and thrombophlebitis, arterial embolism and arterial thrombosis, incl. consequent emergency situations and operations are analyzed from General practice perspectives. Among them: (1) 66 years old patient with multimorbidity, after COVID-19 pneumonia with embolism and thrombosis of a.iliaca. (2) 71 years old patient with COVID-19, atrial fibrillation, diabetes mellitus type 1, essential hypertension, embolism and thrombosis of upper limbs arteriae. (3) 51 year old patient with COVID-19 pneumonia, essential hypertension, phlebitis and thrombophlebitis (DVT) of lower extremities and psychosis, developed during the course of the disease.

Collecting and analyzing such type of complicated cases of patients with multimorbidity and COVID-19 contributes to: (1) better understanding the varieties of combinations of symptoms in COVID-19 patients especially focusing on severe vascular pathology early recognition in General practice setting in order to send such patients timely for hospitalization. (2) raising awareness of GPs regarding some COVID-19 condition as psychosis.

Points for discussion:
1. The role of some clinical tests incl. d-dimer for early detection of COVID-related vascular events

2. Psychosis in COVID-19 patients with CAC and vascular pathology

3. Short-term and long-term observation of COVID-19 patients in General practice during and after recovery