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Diagnosis, Management, and Pathophysiology of Arterial and Venous Thrombosis in COVID-19

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with arterial and venous thrombotic complications. In a US registry of patients with coronavirus disease 2019 (COVID-19), thrombotic complications occurred in 2.6% of 229 non–critically ill hospitalized patients and in 35.3% of 170 hospitalized critically ill patients.1 The risk of thromboembolism in SARS-CoV-2 infection in nonhospitalized patients is unknown. Thrombotic complications include myocardial infarction (MI), ischemic stroke, and venous thromboembolism (VTE). Autopsy findings of microthrombi in multiple organ systems, including the lungs, heart, and kidneys, suggest that thrombosis may contribute to multisystem organ dysfunction in severe COVID-19.2

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Gregory Piazza, MD, MS, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (gpiazza@partners.org).

Published Online: November 23, 2020. doi:10.1001/jama.2020.23422

Conflict of Interest Disclosures: Dr Piazza reported receiving grants from Bristol Myers Squibb, Janssen, Boston Scientific Corporation, Portola, and Bayer and personal fees from the Prairie Education and Research Cooperative, Amgen, Pfizer, and Agile outside the submitted work. Dr Morrow reported receiving grants from Abbott Laboratories, Amgen, Anthos Therapeutics, Esai, GlaxoSmithKline, Takeda, and The Medicines Company; grants and personal fees from AstraZeneca, Merck, Novartis, and Roche Diagnostics; and personal fees from Bayer Pharma and InCarda outside the submitted work and being a member of the TIMI Study Group, which has received institutional research grant support through Brigham and Women's Hospital from Abbott, Amgen, Anthos Therapeutics, Aralez, AstraZeneca, Bayer HealthCare Pharmaceuticals Inc, Daiichi-Sankyo, Eisai, GlaxoSmithKline, Intarcia, Janssen, MedImmune, Merck, Novartis, Pfizer, Poxel, Quark Pharmaceuticals, Regeneron, Roche, Siemens, Takeda, The Medicines Company, and Zora Biosciences.

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