Royal College of Surgeons in Ireland
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Thromboembolic events in deceased patients with proven SARS-CoV-2 infection: frequency, characteristics and risk factors

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journal contribution
posted on 2022-09-15, 16:05 authored by Minna Voigtlaender, Carolin Edler, Moritz Gerling, Julia Schädler, Benjamin Ondruschka, Ann Sophie Schröder, Jan Sperhake, Stephan Ehrhardt, Lin Wang, Munif Haddad, Verena Kiencke, Thomas Renné, Kevin Roedl, Stefan Kluge, Dominic Wichmann, Florian Langer

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


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)



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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 2022

PubMed ID



  • School of Pharmacy and Biomolecular Sciences


Elsevier B.V.


  • Accepted Version (Postprint)