Thromboembolic events in deceased patients with proven SARS-CoV-2 infection: frequency, characteristics and risk factors
Background: Infection with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) results in respiratory syndromes but also in vascular complications such as thromboembolism (TE). In this regard, immunothrombosis, resulting from inflammation in SARS-CoV-2 infected tissues, has been described. Data on TE in COVID-19 are mainly based on clinical observational and/or incomplete autopsy studies. The true burden of TE and the relevance of genetic predisposition, however, have not been resolved.
Objectives: Here, we report on a consecutive cohort of 100 fully autopsied patients deceased by SARS-CoV-2 infections during the first wave of the pandemic (March to April 2020). We investigated the localization of TE, potential clinical risk factors, and the prothrombotic gene mutations, factor V Leiden and prothrombin G20210A, in postmortem blood or tissue samples.
Results: TE was found in 43/100 autopsies. 93 % of TE events were venous occlusions, with 23 patients having pulmonary thromboembolism (PT) with or without lower-extremity deep vein thrombosis. Of these, 70 % showed PT restricted to (sub)segmental arteries, consistent with in situ immunothrombosis. Patients with TE had a significantly higher BMI and died more frequently at an intensive care unit. Hereditary thrombophilia factors were not associated with TE.
Conclusions: Our autopsy results show that a significant proportion of SARS-CoV-2 infected patients suffer from TE, affecting predominantly the venous system. Orthotopic peripheral PT was the most frequent finding. Hereditary thrombophilia appears not to be a determinant for TE in COVID-19. However, obesity and the need for intensive care increase the risk of TE in these patients
Funding
National Network University Medicine, which was supported by the Federal Ministry of Education and Research of Germany
NATON (grant number 01KKX2121)
DEFEAT PANDEMIcs (grant number 01KX2021)
History
Comments
The original article is available at https://www.sciencedirect.com/Published Citation
Voigtlaender M, et al. Thromboembolic events in deceased patients with proven SARS-CoV-2 infection: frequency, characteristics and risk factors. Thromb Res. 2022;218:171-176.Publication Date
28 August 2022External DOI
PubMed ID
36057167Department/Unit
- School of Pharmacy and Biomolecular Sciences
Publisher
Elsevier B.V.Version
- Accepted Version (Postprint)