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A Retrospective Multicenter Study of Arterial Thromboembolic Events in Hospitalized COVID-19 Patients: Incidence and

David Schinz1,2, Marcel Ploch3, Andreas Saleh4

  • 1Department of Neuroradiology, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany. david.schinz@uk-erlangen.de.

Clinical Neuroradiology
|March 4, 2025
PubMed

Insights

COVID-19 is a systemic disease that can cause arterial thrombotic events (ATE), including stroke and heart attack. These events, often occurring within the first week of symptoms, may present with unique imaging features like free-floating clots.

Area of Science:

  • Cardiology
  • Neurology
  • Infectious Diseases

Background:

  • COVID-19 is increasingly recognized as a systemic disease impacting multiple organ systems.
  • The coagulation system is significantly affected in COVID-19 patients, leading to a risk of arterial thrombotic events (ATE).

Purpose of the Study:

  • To investigate the incidence and specific imaging characteristics of ATE in hospitalized COVID-19 patients.
  • To analyze the localization, timing, and clinical associations of ATE in the context of COVID-19.

Main Methods:

  • Retrospective screening of databases from five German tertiary care centers (January 2020 - May 2021).
  • Analysis of 110 ATE cases in 102 COVID-19 patients for localization, timing, imaging features, and clinical/laboratory correlations.

Main Results:

  • 3.1% of hospitalized COVID-19 patients experienced ATE, with ischemic stroke and myocardial infarction being most common.
  • ATE occurred a median of four days after symptom onset, with some cases preceding symptoms.
  • Distinct imaging features, including free-floating clots (10.0%) and multiple occlusions (21.2%), were observed.

Conclusions:

  • COVID-19 is a systemic disease strongly associated with ATE across all vascular regions, particularly the heart and brain.
  • The incidence of ATE in COVID-19 may exceed that of other viral infections.
  • ATE in COVID-19 can exhibit unique imaging characteristics and frequently occur within the first week of diagnosis.
Abstract

Keywords:
Arterial thrombosisCOVID-19EmbolismMulticenterSars-CoV‑2

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