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Table 1 Patient baseline characteristics and parameters for inflammation and coagulopathy.

From: Thrombotic events following tocilizumab therapy in critically ill COVID-19 patients: a Façade for prognostic markers

Variable Patient 1 Patient 2 Patient 3 Patient 4 Patient 5
Age (yrs) 51 79 31 36 51
BMI (kg/m2) 26 33 30 30.7 22.6
Sex Male Male Male Male Male
Past Medical History Diabetes Prostate Carcinoma (remission) Thalassemia, Asthma None Hypertension
Admission Thromboprophylaxis Regimen Heparin SC 5000 TID - Heparin SC 7500 TID on Day 2, based on D Dimer over 3 Heparin SC 5000 TID Enoxaparin 40 mg daily Enoxaparin 40 mg daily, increased to 40 mg BID on day 7 Heparin 7500 TID
Signs of thrombosis Day 3:
On observation, ischemia of the first 3 toes, no capillary refill
Day 17:
No specific signs, bilateral lower extremity ultrasound ordered based on persistently high D Dimer
Day 7:
Bilateral lower limb pain
Day 11:
No specific signs but CT angiogram obtained for persistent severe hypoxemia and high D Dimer
Day 13:
No specific signs but CT chest with IV contrast obtained to rule out collection
Imaging Requested CT Angiogram (abdomen and pelvis with lower extremity runoff):
Floating thrombi noted 4 cm infrarenal abdominal aorta compromising the lumen with total obliteration of the right popliteal artery and right anterior tibial artery
Bilateral lower extremity Ultrasound:
The right posterior tibial vein appears dilated with visible thrombus
Bilateral lower extremity Ultrasound:
Occlusive deep vein thrombosis of the right distal femoral, popliteal, posterior tibial, and peroneal veins, and the left popliteal, gastrocnemius and peroneal veins
CT Angiogram Chest:
Large saddle embolus, extension of embolus into the upper and lower lobar pulmonary arteries with right heart strain
CT Chest with IV Contrast:
Multiple filling defects noted bilaterally in the pulmonary tree; findings consistent with pulmonary embolism. Small filling defect seen in the internal jugular veins bilaterally, consistent with thrombi.
Vascular Intervention 1.Percutaneous mechanical thrombectomy of the infrarenal aorta
2. Left lower extremity intra-arterial thrombolysis
None None None None
Pharmacologic Antithrombotic Therapy for Confirmed thrombosis Heparin Drip per DVT/PE protocol (aPTT target 60–85) Enoxaparin 1 mg/kg BID from day 17 till day 29 of admission when patient developed AKI and switched to heparin drip Enoxaparin 1 mg/kg BID, switched to heparin drip on day 10 of admission Systemic alteplase followed by heparin DVT/PE protocol (aPTT target 60–85) Heparin Drip per DVT/PE protocol (aPTT target 60–85)
  Secondary ischemia of bilateral lower extremity, developing left foot dry gangrene requiring below-knee amputation. Patient improved and discharged on oral anticoagulation. Expired on day 38 of admission, while on heparin drip therapeutic dose for DVT/PE (aPTT target 60–85), CRRT, and mechanical ventilation.
Potential PE
Discharged on oral anticoagulation with apixaban on day 17 of admission Patient improved and was transferred to a medical ward on day 14 of admission and eventually discharged home on oral anticoagulation on day 21 of admission Developed bacteremia and cavitary lung disease with confirmed aspergillosis, which progressed to invasive form with hemoptysis. Patient had a cardiac arrest and expired on day 76 of admission while on therapeutic IV heparin and mechanical ventilation.
Tocilizumab Prior to admission at OSH Day 3 Day 1 Day 3 Day 2
D-Dimer (mcg/mL)
Admission Over 4 Over 4 2.05 0.54 Over 4
At time of event Over 4 Over 4 Over 4 Over 4 Over 4
Platelets (×10*9/L)
Admission 311 180 311 201 278
At time of event 218 161 218 474 515
C-Reactive protein (mg/L)
Admission 8 193 63.2 59.3 307.5
At time of event 3.8 49 3.8 3.5 297.2
Fibrinogen (g/L)
Admission 1.88 NA 6.57 4.53 7.06
At time of event 1.4 5.01 3.29 2.53 NA
Lupus Anticoagulant Negative N/A Positive Positive Positive