Some Patients With COVID-19 First Present With Arterial Thrombosis

Clogged arteries. arterial plaque
Clogged arteries. arterial plaque. Medical background. 3d illustration
Researchers aimed to study the clinical characteristics, treatments, and outcomes of unexpected acute arterial thrombosis in patients with COVID-19.

A retrospective analysis found that some patients with COVID-19 present with arterial thrombosis as the first symptom. The study findings were published in the journal Vascular.

The arterial thrombosis in COVID-19 (ARTICO-19) was an interventional registry comprising 21 centers in 9 countries in Latin America and Spain. Inpatients (N=81) with confirmed SARS-CoV-2 and arterial thrombotic complications between December 2019 and August 2020 were assessed for risk factors and outcomes.

Patients had a mean age of 64.8±14.1 years; 67.9% were men; 50.0% had hypertension; 36.0% were on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers; 26.6% had diabetes; 24.4% dyslipidemia; 24.1% had a history of smoking; and 14.8% were active smokers.

Over a third of patients (38.3%) first presented with ischemia-related symptoms and most patients had acute limb ischemia (97.5%). The thrombus occurred above the knee (45.0%), aorta and lower limb (14.8%), upper limb (14.8%), below the knee (13.8%), abdominal aorta (5.0%), above and below the knee (3.8%), visceral above the knee (1.3%) visceral below the knee (1.3%), and thoracic aorta (1.3%).

No baseline characteristics differed significantly between the cohort of patients who first presented with arterial thrombosis or respiratory symptoms.

Over a third of patients (36.5%) developed acute distress respiratory syndrome, 25.7% developed pneumonia, 12.2% had mild symptoms, and 25.7% were asymptomatic. Fewer patients with severe disease received surgical interventions (11.1% vs 88.9%; P =.004). More patients with severe disease were admitted to the intensive care unit (P =.001) and died (P =.015).

Risk for death or major amputation associated with severity of COVID-19 (adjusted odds ratio [aOR], 2.10; 95% CI, 1.21-3.66; P =.008).

The study was limited, as the first-line treatment protocols differed substantially between treatment centers.

Overall, the study found that some patients with COVID-19 presented with arterial thrombosis, particularly acute limb ischemia before respiratory symptoms.

“Arterial thrombosis can be the initial symptom in patients presenting with COVID-19,” the study authors said. “Therefore, physicians and health workers should potentially suspect COVID-19 in [acute limb ischemia] cases without a known risk factor or embolic cause. More experimental and clinical research is required to understand the complex phenomenon of arterial COVID-19-induced coagulopathy.”


Gonzalez-Urquijo M, Gonzalez-Rayas JM, Castro-Varela A, et al. Unexpected arterial thrombosis and acute limb ischemia in COVID-19 patients. Results from the Ibero-Latin American acute arterial thrombosis registry in COVID-19: (ARTICO-19). Vascular. Published online December 4, 2021. doi:10.1177/17085381211052033