Phlegmasia Cerulea Dolens Associated with Acute COVID-19 Pneumonia Despite Supratherapeutic Warfarin Anticoagulation

ABSTRACT: Patients with acute Coronavirus-19 (COVID-19) respiratory infections are associated with concomitant thromboembolic complications and a hypercoagulable state. Although these mechanisms are not completely understood, unique alterations in serum markers for hemostasis and thrombosis have been detected. A high index of suspicion is required by vascular surgeons in patients presenting with this novel virus. We present the case of a 51 year old male with acute COVID-19 pneumonia who developed Phlegmasia Cerulea Dolens despite chronic warfarin therapy and a supratherapeutic International Normalized Ratio (INR).