tetano
Editor, Senior Moderator
Thromb Res
. 2022 Aug 28;218:171-176.
doi: 10.1016/j.thromres.2022.08.021. Online ahead of print.
Thromboembolic events in deceased patients with proven SARS-CoV-2 infection: Frequency, characteristics and risk factors
Minna Voigtlaender[SUP] 1 [/SUP], Carolin Edler[SUP] 2 [/SUP], Moritz Gerling[SUP] 2 [/SUP], Julia Schädler[SUP] 2 [/SUP], Benjamin Ondruschka[SUP] 2 [/SUP], Ann Sophie Schröder[SUP] 2 [/SUP], Jan Sperhake[SUP] 2 [/SUP], Stephan Ehrhardt[SUP] 3 [/SUP], Lin Wang[SUP] 3 [/SUP], Munif Haddad[SUP] 4 [/SUP], Verena Kiencke[SUP] 4 [/SUP], Thomas Renné[SUP] 5 [/SUP], Kevin Roedl[SUP] 6 [/SUP], Stefan Kluge[SUP] 6 [/SUP], Dominic Wichmann[SUP] 6 [/SUP], Florian Langer[SUP] 7 [/SUP]
Affiliations
Abstract
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.
Keywords: Autopsy; Body mass index; COVID-19; Hereditary thrombophilia; Intensive care unit; Thromboembolism.
. 2022 Aug 28;218:171-176.
doi: 10.1016/j.thromres.2022.08.021. Online ahead of print.
Thromboembolic events in deceased patients with proven SARS-CoV-2 infection: Frequency, characteristics and risk factors
Minna Voigtlaender[SUP] 1 [/SUP], Carolin Edler[SUP] 2 [/SUP], Moritz Gerling[SUP] 2 [/SUP], Julia Schädler[SUP] 2 [/SUP], Benjamin Ondruschka[SUP] 2 [/SUP], Ann Sophie Schröder[SUP] 2 [/SUP], Jan Sperhake[SUP] 2 [/SUP], Stephan Ehrhardt[SUP] 3 [/SUP], Lin Wang[SUP] 3 [/SUP], Munif Haddad[SUP] 4 [/SUP], Verena Kiencke[SUP] 4 [/SUP], Thomas Renné[SUP] 5 [/SUP], Kevin Roedl[SUP] 6 [/SUP], Stefan Kluge[SUP] 6 [/SUP], Dominic Wichmann[SUP] 6 [/SUP], Florian Langer[SUP] 7 [/SUP]
Affiliations
- PMID: 36057167
- DOI: 10.1016/j.thromres.2022.08.021
Abstract
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.
Keywords: Autopsy; Body mass index; COVID-19; Hereditary thrombophilia; Intensive care unit; Thromboembolism.