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. 2020 Nov;50(4):790-794.
doi: 10.1007/s11239-020-02245-x. Epub 2020 Aug 13.

In vivo demonstration of microvascular thrombosis in severe COVID-19

Douglas Alexandre do Espírito Santo  1 , Anna Cristina Bertoldi Lemos  1 , Carlos Henrique Miranda  2
Affiliations

In vivo demonstration of microvascular thrombosis in severe COVID-19

Douglas Alexandre do Espírito Santo et al. J Thromb Thrombolysis. 2020 Nov.

Abstract

Several autopsy studies showed microthrombi in pulmonary circulation of severe COVID-19 patients. The major limitation of these investigations is that the autopsy provided static information. Some of these alterations could be secondary to the disseminated intravascular coagulation (DIC) observed as the final standard route to the multisystem organ failure exhibited in critically ill patients. We report preliminary results of an in vivo evaluation of sublingual microcirculation in thirteen patients with severe COVID-19 requiring mechanical ventilation. We observed multiple filling defects moving within the microvessels indicative of thrombi in most of the cases 11/13 (85%). This is the first imaging documentation of microvascular thrombosis in living severe COVID-19 patients since the beginning of the hospitalization. The clinical relevance of microvascular thrombosis in this disease requires further research.

Keywords: COVID-19; Coagulopathy; Microvascular thrombosis; Sublingual microcirculation.

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Conflict of interest statement

All authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Normal sublingual microcirculation in a healthy individual (a‒b). Presence of several filling defects (arrows) moving inside the microvessels indicative of thrombi (c‒e) in severe COVID-19 patients. Microvessel with interrupted flow showing semi-oval imaging (asterisk) in its distal extremity compatible with acute thromboembolic occlusion (f) in COVID-19 patient
See this image and copyright information in PMC

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