Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Apr 15;22(2):95-97.
doi: 10.51893/2020.2.pov2. Online ahead of print.

Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): an atypical acute respiratory distress syndrome working hypothesis

Fabio Ciceri  1 , Luigi Beretta  2 , Anna Mara Scandroglio  2 , Sergio Colombo  2 , Giovanni Landoni  3 , Annalisa Ruggeri  1 , Jacopo Peccatori  1 , Armando D'Angelo  4 , Francesco De Cobelli  2 , Patrizia Rovere-Querini  2 , Moreno Tresoldi  5 , Lorenzo Dagna  2 , Alberto Zangrillo  2
Affiliations

Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): an atypical acute respiratory distress syndrome working hypothesis

Fabio Ciceri et al. Crit Care Resusc. .

Abstract

We suggest the use of MicroCLOTS (microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome) as a new name for severe pulmonary coronavirus disease 2019 (COVID-19). We hypothesise that, in predisposed individuals, alveolar viral damage is followed by an inflammatory reaction and by microvascular pulmonary thrombosis. This progressive endothelial thromboinflammatory syndrome may also involve the microvascular bed of the brain and other vital organs, leading to multiple organ failure and death. Future steps in the understanding of the disease and in the identification of treatments may benefit from this definition and hypothesised sequence of events.

Keywords: COVID-19.

PubMed Disclaimer

Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
MicroCLOTS (microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome) as an atypical acute respiratory distress syndrome working hypothesis
See this image and copyright information in PMC

Comment in

References

    1. World Health Organization Clinical management of severe acute respiratory infection when COVID-19 is suspected. Interim guidance. Version 1.2. 13 March 2020 https://www.who.int/publications-detail/clinical-management-of-severe-ac... (viewed Apr 2020)
    1. Huang C., Wang Y., Li X., et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan. China. Lancet. 2020;395:497–506. - PMC - PubMed
    1. Guan W.J., Ni Z.Y., Hu Y., et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020 doi: 10.1056/NEJMoa2002032. [Epub ahead of print] - DOI - PMC - PubMed
    1. Herold T., Jurinovic V., Arnreich C., et al. Level of IL-6 predicts respiratory failure in hospitalized symptomatic COVID-19 patients. BMJ. 2020 doi: 10.1101/2020.04.01.20047381. [Preprint, 10 April 2020] - DOI
    1. Hamming I., Timens W., Bulthuis M.L.C., et al. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203:631–637. - PMC - PubMed