Pulmonary Arterial Thrombosis in COVID-19 With Fatal Outcome
Authors: Sigurd F. Lax, Kristijan Skok, Peter M. Zechner, Michael Trauner
Journal: Annals of Internal Medicine (2021)

LettersJanuary 2021Pulmonary Arterial Thrombosis in COVID-19 With Fatal OutcomeSigurd F. Lax, MD, PhD, Kristijan Skok, MD, Peter M. Zechner, MD, and Michael Trauner, MD, PhDSigurd F. Lax, MD, PhDHospital Graz II, Academic Teaching Hospital of the Medical University of Graz, Graz, Austria, and Johannes Kepler University Linz, Linz, Austria, Kristijan Skok, MDHospital Graz II, Academic Teaching Hospital of the Medical University of Graz, Graz, Austria, Peter M. Zechner, MDHospital Graz II, Academic Teaching Hospital of the Medical University of Graz, Graz, Austria, and Michael Trauner, MD, PhDMedical University of Vienna, Vienna, AustriaAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1276 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Nichols raises potential concerns about the nature of the thrombotic material found in the lungs of patients with COVID-19 who have died and its possible therapeutic implications. In our study, we critically distinguished among thrombi, thromboemboli, and postmortem clots. We believe that the observed inflammatory reaction and infarcts clearly indicate that the thrombotic material arose before death. Neutrophil infiltrates in both vessel walls and thrombi (Figure 3, panels A, B, and D) occur only in vivo and clearly speak against postmortem clots.The vessels occluded by thrombosis were found adjacent to or within areas of infarction (Figure ...References1. Barrett CD, Moore HB, Yaffe MB, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19: a comment [Letter]. J Thromb Haemost. 2020;18:2060-3. [PMID: 32302462] doi10.1111/jth.14860 CrossrefMedlineGoogle Scholar2. Wichmann D, Sperhake JP, Lütgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID-19. A prospective cohort study. Ann Intern Med. 2020;173:268-77. doi:10.7326/M20-2003 LinkGoogle Scholar3. Bösmüller H, Traxler S, Bitzer M, et al. The evolution of pulmonary pathology in fatal COVID-19 disease: an autopsy study with clinical correlation. Virchows Arch. 2020;477:349-57. [PMID: 32607684] doi:10.1007/s00428-020-02881-x CrossrefMedlineGoogle Scholar4. Magro C, Mulvey JJ, Berlin D, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Transl Res. 2020;220:1-13. [PMID: 32299776] doi:10.1016/j.trsl.2020.04.007 CrossrefMedlineGoogle Scholar5. Cattaneo M, Bertinato EM, Birocchi S, et al. Pulmonary embolism or pulmonary thrombosis in COVID-19? Is the recommendation to use high-dose heparin for thromboprophylaxis justified? [Letter]. Thromb Haemost. 2020;120:1230-2. [PMID: 32349132] doi:10.1055/s-0040-1712097 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Sigurd F. Lax, MD, PhD; Kristijan Skok, MD; Peter M. Zechner, MD; Michael Trauner, MD, PhDAffiliations: Hospital Graz II, Academic Teaching Hospital of the Medical University of Graz, Graz, Austria, and Johannes Kepler University Linz, Linz, AustriaHospital Graz II, Academic Teaching Hospital of the Medical University of Graz, Graz, AustriaMedical University of Vienna, Vienna, AustriaDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-2566. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPulmonary Arterial Thrombosis in COVID-19 With Fatal Outcome Sigurd F. Lax , Kristijan Skok , Peter Zechner , Harald H. Kessler , Norbert Kaufmann , Camillo Koelblinger , Klaus Vander , Ute Bargfrieder , and Michael Trauner Pulmonary Arterial Thrombosis in COVID-19 With Fatal Outcome Larry Nichols Metrics Cited byCOVID-19 and hepatic injury: Diversity and risk assessmentMetabolic Regulation of Inflammation and Its Resolution: Current Status, Clinical Needs, Challenges, and OpportunitiesCOVID-19: The Impact on Cardiovascular System January 2021Volume 174, Issue 1Page: 139-140KeywordsArteriesCOVID-19DisclosureForecastingLungsPulmonary embolismPulmonary vascular diseasesThrombosisUpper respiratory tract infectionsVascular diseases ePublished: 19 January 2021 Issue Published: January 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...