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Cited by 434COVID-19 Clinical Research StudiesLong-Term Effects of COVID-19COVID-19 and healthcare impacts

Arterial Thrombosis in Coronavirus Disease 2019 Patients: A Rapid Systematic Review

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Cheruiyot, Isaac, Kipkorir, Vincent, Ngure, Brian, Misiani, Musa, Munguti, Jeremiah, Ogeng'o, Julius·2021·Annals of Vascular Surgery
DOI 10.1016/j.avsg.2020.08.087PMC PMC7453204
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Abstract

Background Emerging evidence suggests that severe form of coronavirus disease 2019 (COVID-19) is mediated, in part, by a hypercoagulable state characterized by micro- and macro-vascular thrombotic angiopathy. Although venous thrombotic events in COVID-19 patients have been well described, data on arterial thrombosis (AT) in these patients is still limited. We, therefore, conducted a rapid systematic review of current scientific literature to identify and consolidate evidence of AT in COVID-19 patients. Methods A systematic search of literature was conducted between November 1, 2019, and June 9, 2020, on PubMed and China National Knowledge Infrastructure to identify potentially eligible studies. Results A total of 27 studies (5 cohort, 5 case series, and 17 case reports) describing arterial thrombotic events in 90 COVID-19 patients were included. The pooled incidence of AT in severe/critically ill intensive care unit-admitted COVID-19 patients across the 5 cohort studies was 4.4% (95% confidence interval 2.8-6.4). Most of the patients were male, elderly, and had comorbidities. AT was symptomatic in >95% of these patients and involved multiple arteries in approximately 18% of patients. The anatomical distribution of arterial thrombotic events was wide, occurring in limb arteries (39%), cerebral arteries (24%), great vessels (aorta, common iliac, common carotid, and brachiocephalic trunk; 19%), coronary arteries (9%), and superior mesenteric artery (8%). The mortality rate in these patients is approximately 20%. Conclusions AT occurs in approximately 4% of critically ill COVID-19 patients. It often presents symptomatically and can affect multiple arteries. Further investigation of the underlying mechanism of AT in COVID-19 would be needed to clarify possible therapeutic targets.

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  • Cheruiyot et al. identified higher prevalence of deep venous thrombosis in male and older COVID-19 infected patients.

    “Cheruiyot et al.54 also identified higher prevalence of deep venous thrombosis in male and older COVID-19 infected patients.”

    From Portal-splenic-mesenteric venous thrombosis in COVID-19 patients: a systematic review (2025) · cites this paper as Cheruiyot et al.54

    The Results (Data Synthesis, ‘Age and Sex Distribution of Patients with AT’; page not provided) report that most patients with arterial thrombotic events were male and that few reported cases involved patients under 50. The finding concerns arterial thrombosis, not deep venous thrombosis, so the claimed event type is unsupported. (LLM, conf=0.88)

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  • Male sex and age are risk factors previously reported by other authors.

    “Male sex and age are also risk factors previously reported by other authors.”

    From Portal-splenic-mesenteric venous thrombosis in COVID-19 patients: a systematic review (2025) · cites this paper as Cheruiyot et al.54

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  1. [3]Hassan S.A. Sheikh F.N. Jamal S. Coronavirus (COVID-19): a review of clinical features, diagnosis, and treatment Cureus 12 2020 PMC7170025 32328367
  2. [4]Di Gennaro F. Pizzol D. Marotta C. Coronavirus diseases (COVID-19) current status and future perspectives: a narrative review Int J Environ Res Public Health 17 2020 2690 32295188 PMC7215977
  3. [5]Henry B.M. Vikse J. Benoit S. Hyperinflammation and derangement of renin-angiotensin-aldosterone system in COVID-19: a novel hypothesis for clinically suspected hypercoagulopathy and microvascular immunothrombosis Clinica Chim Acta 507 2020 167 173 PMC7195008 32348783
  4. [6]Spiezia L. Boscolo A. Poletto F. COVID-19-related severe hypercoagulability in patients admitted to intensive care unit for acute respiratory failure Thromb Haemost 120 2020 998 1000 32316063 PMC7295272
  5. [7]Lippi G. Favaloro E.J. D-dimer is associated with severity of coronavirus disease 2019: a pooled analysis Thromb Haemost 120 2020 876 878 32246450 PMC7295300
  6. [9]Mehta P. McAuley D.F. Brown M. COVID-19: consider cytokine storm syndromes and immunosuppression The Lancet 395 2020 1033 1034 PMC7270045 32192578
  7. [10]McGonagle D. Sharif K. O'Regan A. Interleukin-6 use in COVID-19 pneumonia related macrophage activation syndrome Autoimmun Rev 19 2020 102537 32251717 PMC7195002
  8. [11]Klok F.A. Kruip M.J. Van der Meer N.J. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: an updated analysis Thromb Res 191 2020 148 150 32381264 PMC7192101
  9. [12]Andrea V. Gianluca F. Rodolfo P. Unheralded lower limb threatening ischemia in a COVID-19 patient Int J Infect Dis 96 2020 590 592 32447121 PMC7242202
  10. [13]Ahmed I. Azhar A. Eltaweel N. First Covid-19 maternal mortality in the UK associated with thrombotic complications Br J Haematol 190 2020 e37 e38 32420614 PMC7276811
  11. [15]Baldacini M. Pop R. Sattler L. Concomitant hemorrhagic syndrome and recurrent extensive arterial thrombosis in a patient with COVID-19 and acute promyelocytic leukemia Br J Haematol 89 2020 1054 1056 PMC7267249 32369614
  12. [16]de Barry O. Mekki A. Diffre C. Arterial and venous abdominal thrombosis in a 79-year-old woman with COVID-19 pneumonia Radiol Case Rep 15 2020 1054 1057 32351657 PMC7188660
  13. [17]a Beccara L. Pacioni C. Ponton S. Arterial mesenteric thrombosis as a complication of SARS-CoV-2 infection Eur J Case Rep Intern Med 7 2020 001690 32399456 PMC7213834
  14. [18]Bellosta R. Luzzani L. Natalini G. Acute limb ischemia in patients with COVID-19 pneumonia J Vasc Surg 2020 Apr S0741521420310806 PMC7188654 32360679
  15. [19]Fraissé M. Logre E. Pajot O. Thrombotic and hemorrhagic events in critically ill COVID-19 patients: a French monocenter retrospective study Crit Care 24 2020 1 4 32487122 PMC7265664
  16. [20]Giacomelli E. Dorigo W. Fargion A. Acute thrombosis of an aortic prosthetic graft in a patient with severe COVID-19–related pneumonia Ann Vasc Surg 66 2020 8 10 S0890509620303666 32360432 PMC7188652
  17. [21]Goldberg M.F. Goldberg M.F. Cerejo R. Cerebrovascular disease in COVID-19 AJNR Am J Neuroradiol 2020 May 14 ajnr;ajnr.A6588v1 PMC7357639 32409316
  18. [22]Gomez-Arbelaez D. Ibarra-Sanchez G. Garcia-Gutierrez A. COVID-19-related aortic thrombosis: a report of four cases Ann Vasc Surg 67 2020 10 13 32474145 PMC7256515
  19. [23]Harari R. Bangalore S. Chang E. COVID -19 complicated by acute myocardial infarction with extensive thrombus burden and cardiogenic shock Catheter Cardiovasc Interv 2020 May 19 ccd.28992 PMC7276857 32427416
  20. [24]CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis) Helms J. Tacquard C. Severac F. High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study Intensive Care Med [Internet] 2020 May 4 [cited 2020 May 23]; Available from: http://link.springer.com/10.1007/s00134-020-06062-x PMC7197634 32367170 · DOI
  21. [25]Kashi M. Jacquin A. Dakhil B. Severe arterial thrombosis associated with Covid-19 infection Thromb Res 192 2020 75 77 32425264 PMC7229939
  22. [26]Kaur P. Qaqa F. Ramahi A. Acute upper limb ischemia in a patient with COVID-19 Hematology/Oncology and Stem Cell Therapy 2020 May S1658387620300960 PMC7219365 32405288
  23. [27]Le Berre A. Marteau V. Emmerich J. Concomitant acute aortic thrombosis and pulmonary embolism complicating COVID-19 pneumonia Diagn Interv Imaging 101 2020 321 322 32334995 PMC7161476
  24. [28]Lodigiani C. Iapichino G. Carenzo L. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy Thromb Res 191 2020 9 14 32353746 PMC7177070
  25. [29]Malentacchi M. Gned D. Angelino V. Concomitant brain arterial and venous thrombosis in a COVID-19 patient Eur J Neurol 27 2020 e38 e39 32503080 PMC7300879
  26. [30]Mestres G. Puigmacià R. Blanco C. Risk of peripheral arterial thrombosis in COVID-19 J Vasc Surg 72 2020 756 757 S0741521420310740 32417015 PMC7203033
  27. [31]Nassabein R. Routy B. Blais N. Arterial thrombosis and coronavirus disease 2019 in a patient with cancer Eur J Cancer 134 2020 1 2 32454394 PMC7231757
  28. [32]Perini P. Nabulsi B. Massoni C.B. Acute limb ischaemia in two young, non-atherosclerotic patients with COVID-19 The Lancet 395 2020 1546 PMC7200129 32423583
  29. [33]Rey J.R. Valero S.J. Pinedo D.P. COVID-19 y trombosis simultánea en dos arterias coronarias Rev Esp Cardiol 73 2020 676 678 PMC7218359 32405136
  30. [34]Reyes Valdivia A. Gómez Olmos C. Ocaña Guaita J. Cardiovascular examination should also include peripheral arterial evaluation for COVID-19 patients J Vasc Surg 72 2020 758 760 PMC7190486 32361070
  31. [35]Thomas W. Varley J. Johnston A. Thrombotic complications of patients admitted to intensive care with COVID-19 at a teaching hospital in the United Kingdom Thromb Res 191 2020 76 77 32402996 PMC7182517
  32. [36]Viguier A. Delamarre L. Duplantier J. Acute ischemic stroke complicating common carotid artery thrombosis during a severe COVID-19 infection J Neuroradiology 47 2020 393 394 PMC7196531 32389423
  33. [37]Vulliamy P. Jacob S. Davenport R.A. Acute aorto-iliac and mesenteric arterial thromboses as presenting features of COVID-19 Br J Haematol 189 2020 1053 1054 32353183 PMC7267618
  34. [39]Varga Z. Flammer A.J. Steiger P. Endothelial cell infection and endotheliitis in COVID-19 The Lancet 395 2020 1417 1418 PMC7172722 32325026
  35. [40]Teuwen L.A. Geldhof V. Pasut A. COVID-19: the vasculature unleashed Nat Rev Immunol 20 2020 389 391 32439870 PMC7240244
  36. [41]Watanabe T. Barker T.A. Berk B.C. Angiotensin II and the endothelium: diverse signals and effects Hypertension 45 2005 163 169 15630047
  37. [42]Lovren F. Pan Y. Quan A. Angiotensin converting enzyme-2 confers endothelial protection and attenuates atherosclerosis Am J Physiology-Heart Circulatory Physiol 295 2008 H1377 H1384 18660448
  38. [43]Panigada M. Bottino N. Tagliabue P. Grasselli G. Novembrino C. Chantarangkul V. Hypercoagulability of COVID-19 patients in intensive care unit. A Report of Thromboelastography Findings and Other Parameters of Hemostasis. J Thromb Haemost [Internet]. [cited 2020 May 24];n/a(n/a) Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/jth.14850 PMC9906150 32302438 · DOI
  39. [44]Favaloro E.J. Franchini M. Lippi G. Aging hemostasis: changes to laboratory markers of hemostasis as we age—a narrative review InSeminars Thromb Hemost 40 2014 621 633 Thieme Medical Publishers 25099191
  40. [45]Mari D. Ogliari G. Castaldi D. Hemostasis and ageing Immun Ageing 5 2008 12 18947391 PMC2602988
  41. [47]Man J.J. Beckman J.A. Jaffe I.Z. Sex as a biological variable in atherosclerosis Circ Res 126 2020 1297 1319 32324497 PMC7185045
  42. [48]Fairweather D. Sex differences in inflammation during atherosclerosis Clin Med Insights Cardiol 8 Suppl 3 2014 49 59 PMC4405090 25983559
  43. [49]Meng Y. Wu P. Lu W. Sex-specific clinical characteristics and prognosis of coronavirus disease-19 infection in Wuhan, China: a retrospective study of 168 severe patients. PLoS Pathog [Internet]. 2020 Apr 28 [cited 2020 May 24];16(4) Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7209966/ PMC7209966 32343745
  44. [50]Zhao M. Wang M. Zhang J. Advances in the relationship between coronavirus infection and cardiovascular diseases. Biomed Pharmacother [Internet]. 2020 May 13 [cited 2020 May 24] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218375/ PMC7218375 32428835
  45. [51]Du R.-H. Liang L.-R. Yang C.-Q. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study Eur Respir J 55 2020 1 8 PMC7144257 32269088
  46. [52]Kuypers J. Martin E.T. Heugel J. Clinical disease in children associated with newly described coronavirus subtypes Pediatrics 119 2007 e70 e76 17130280
  47. [53]Varghese L. Zachariah P. Vargas C. Epidemiology and clinical features of human coronaviruses in the pediatric population J Pediatr Infect Dis Soc 7 2018 151 158 PMC5954244 28482105
  48. [54]Kim G.B. Park S. Kwon B.S. Evaluation of the temporal association between Kawasaki disease and viral infections in South Korea Korean Circ J 44 2014 250 254 25089137 PMC4117846
  49. [55]Boukhris M. Hillani A. Moroni F. Cardiovascular implications of the COVID-19 pandemic: a global perspective. Can J Cardiol [Internet]. 2020 May 16 [cited 2020 May 24] Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229739/ PMC7229739 32425328
  50. [56]Mozos I. Malainer C. Horbańczuk J. Inflammatory markers for arterial stiffness in cardiovascular diseases. Front Immunol [Internet]. 2017 Aug 31 [cited 2020 May 24];8 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583158/ PMC5583158 28912780
  51. [57]Golia E. Limongelli G. Natale F. Inflammation and cardiovascular disease: from pathogenesis to therapeutic target Curr Atheroscler Rep 16 2014 435 25037581
  52. [58]Krzysztof K. Erzsebet K. Fass David N. Influence of anatomical location on arterial thrombosis Arterioscler Thromb Vasc Biol 22 2002 342 347 11834539

Cited by

Sorted by citations

Authors
Cheruiyot, I., Kipkorir, V., Ngure, B., Misiani, M., Munguti, J., & Ogeng'o, J.
Affiliations
University of Nairobi (KE)
Corresponding author
Cheruiyot, Isaac
ORCID
Venue
Annals of Vascular Surgery
Publisher
Elsevier BV
Published
2021-01
Volume
70
Pages
273-281
ISSN
0890-5096 (ISSN-L)
DOI
10.1016/j.avsg.2020.08.087
PMC
PMC7453204
OpenAlex
W3080236684
Cited by
434
References
5
Citations by year
2026: 2 · 2025: 8 · 2024: 13 · 2023: 30 · 2022: 48 · 2021: 328 · 2020: 5
FWCI
4.85
Type
journal article
Language
en
Open access
Licence
Locations
  • Annals of Vascular Surgery (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
  • Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
Keywords
COVID-19 pandemic, arterial thrombosis, hypercoagulability, critically ill patients, limb arteries, cerebral arteries, coronary arteries, superior mesenteric artery, thrombosis incidence, mortality
MeSH terms
COVID-19, SARS-CoV-2, Adult, Aged, Aged, 80 and over, Arterial Occlusive Diseases, Blood Coagulation, Humans, Male, Middle Aged, Prognosis, Risk Factors, Thrombosis, Incidence, Host-Pathogen Interactions

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