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Thromboembolic involvement and its possible pathogenesis in COVID-19 mortality: lesson from post-mortem reports
K Dwiputra Hernugrahanto1, D Novembri Utomo, H Hariman
1Doctoral Programme, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia. djoko-santoso@fk.unair.ac.id.
European Review for Medical and Pharmacological Sciences
|February 25, 2021
Summary
Autopsy reports reveal that Coronavirus Disease 19 (COVID-19) causes widespread thrombosis and coagulopathy. Megakaryocyte involvement in COVID-19 pathophysiology and thromboembolic events is increasingly recognized.
Area of Science:
- Pathology
- Hematology
- Infectious Diseases
Background:
- Coronavirus Disease 19 (COVID-19) has emerged as a global pandemic, causing significant mortality.
- Clinical and autopsy findings indicate COVID-19 leads to acute respiratory distress syndrome (ARDS) and multiorgan pathologies, including endothelialitis and thrombosis.
- Coagulopathy in COVID-19 is linked to megakaryocytes, critical for platelet homeostasis, though their specific role in autopsy findings is sparsely reported.
Purpose of the Study:
- To review and summarize the potential involvement and pathophysiology of thromboembolic events in COVID-19 patients.
- To analyze findings from post-mortem reports concerning thrombosis and megakaryocytes in COVID-19.
Main Methods:
- Systematic review of post-mortem reports from March 2020 to September 2020.
- Inclusion criteria focused on reports demonstrating macroscopic or microscopic thromboembolic involvement.
- Eleven autopsy reports meeting the criteria were analyzed for findings related to thrombosis and megakaryocytes.
Main Results:
- Consistent pulmonary gross findings were reported across all included studies.
- Pulmonary embolism, coagulopathy, severe endothelial injury, and widespread thrombosis are frequent in COVID-19 patients.
- Associated laboratory findings include elevated D-Dimer, increased fibrinogen, abnormal prothrombic coagulation, and thrombocytopenia; thrombi were also found in deep veins and the prostatic plexus.
Conclusions:
- COVID-19 is associated with significant thromboembolic complications, including pulmonary embolism and deep vein thrombosis.
- The pathophysiology likely involves a complex interplay between SARS-CoV-2, platelets, leukocytes, endothelial cells, inflammation, and immune responses.
- The role of megakaryocytes in COVID-19-associated thrombosis warrants further investigation to elucidate cellular and humoral interactions.
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