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Autopsy findings and venous thromboembolism in patients with COVID-19

Our take —

In a small autopsy series of patients dying with COVID-19, pulmonary emboli and deep vein thromboses were frequently found, even in patients without suspected clot burden. This adds important data to recent evidence of hypercoagulability in COVID-19, and adds support for the use of antithrombotic medications for patients with COVID-19.

Study design

Case Series

Study population and setting

The study included antemortem laboratory and imaging results, and postmortem autopsy and imaging findings from the first 12 patients known to have died with a SARS-CoV-2 infection in Hamburg, Germany. Autopsies were performed between 1 and 5 days after death. The median age of the patients was 73 years, and 75% were men. Before autopsy, none of the patients had a suspected pulmonary embolus or deep vein thrombosis (DVT).

Summary of Main Findings

Patients dying with COVID-19 had elevated levels of lactate dehydrogenase, D-dimer, and C-reactive protein. In 4 of 12 cases, massive pulmonary embolism was determined to be the cause of death. In a further 3 cases, bilateral DVTs were found. All patients were determined to have a pulmonary cause of death. Common findings included diffuse alveolar damage and pulmonary congestion. SARS-CoV-2 RNA was detected in all 12 pulmonary specimens, and in 9 pharyngeal specimens. Six patients were found to have virus in the blood.

Study Strengths

The study included comprehensive imaging and autopsy procedures.

Limitations

The small sample size limited the strength of any inferences. Further, because the study included the first 12 patients, there may have been selection for most sick, elderly, or frail individuals. Thus, the findings may not be generalizable to the broader COVID-19 population. Finally, there was little ability to correlate laboratory findings with autopsy results based on the information provided.

Value added

This study is among the first descriptions of autopsy results for patients dying with COVID-19

This review was posted on: 22 June 2020