High Incidence of Thromboembolic Events in Patients Who Died of COVID-19

A high incidence of thromboembolic events, including deep venous thrombosis (DVT) and pulmonary embolism, was found in an autopsy study of 12 patients who died of COVID-19, according to a study published in the Annals of Internal Medicine.

This was an analysis of complete autopsy results from older adults (median age, 73 years; range, 52-87 years; 75% men) with a COVID-19 diagnosis confirmed by polymerase chain reaction who were treated at a German academic medical center (10 and 2 patients died in and outside the hospital, respectively). The analysis included postmortem computed tomography (CT) and histopathologic and virologic findings.

The most common comorbid conditions in those patients were coronary heart disease (50%) and asthma or chronic obstructive pulmonary disease (25%). Seven patients (58%) who did not have suspected venous thromboembolism prior to death had evidence of DVT at autopsy. In 4 patients, pulmonary embolism was the primary cause of death.

In 8 patients, postmortem CT indicated reticular infiltration of the lungs with severe bilateral, dense consolidation. Eight patients had histomorphologically diffuse alveolar damage. High concentrations of severe acute respiratory syndrome coronavirus 2 RNA was detected in the lungs of all patients. Moderate viremia was found in 6 patients, and 5 patients had high viral RNA titers detected in the liver, kidney, or heart.

A limitation of this study is its small sample size, which may have led to an overestimation of the rate of pulmonary embolism.

“When hemodynamic deterioration occurs in a patient with COVID-19, pulmonary embolism should always be suspected. That patients with COVID-19 who have increased D-dimer levels, a sign of coagulopathy, may benefit from anticoagulant treatment seems plausible,” noted the study authors.

Reference

Wichmann D, Sperhake JP, Lütgehetmann M, et al. Autopsy findings and venous thromboembolism in patients with COVID-19: A prospective cohort study [published online May 6, 2020]. Ann Intern Med. doi:10.7326/M20-2003