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.

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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