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Autopsy Findings and Venous Thromboembolism in Patients With COVID-19

Autopsy Findings and Venous Thromboembolism in Patients With COVID-19

06 May 2020 | Dominic Wichmann, MD*; Jan-Peter Sperhake, MD*; Marc Lütgehetmann, MD; Stefan Steurer, MD; Carolin Edler, MD; Axel Heinemann, MD; Fabian Heinrich; Herbert Mushumba, MD; Inga Kniep, MD; Ann Sophie Schröder, MD; Christoph Burdelski, MD; Geraldine de Heer, MD; Axel Nierhaus, MD; Daniel Frings, MD; Susanne Pfefferle, MD; Heinrich Becker, MD; Hanns Bredercke-Wiedling, MD; Andreas de Weerth, MD; Hans-Richard Paschen, MD; Sara Sheikhzadeh-Eggers, MD; Axel Stang, MD; Stefan Schmiedel, MD; Carsten Bokemeyer, MD; Marylyn M. Addo, MD, PhD; Martin Aepfelbacher, MD; Klaus Püschel, MD†; and Stefan Kluge, MD†
This prospective cohort study investigates the causes of death and pathologic features in patients with COVID-19 through complete autopsies, including postmortem computed tomography (PMCT), histopathologic analysis, and virologic testing. The study included 12 consecutive COVID-19–positive deaths, with a median age of 73 years and a male predominance. Common comorbidities included coronary heart disease and asthma or chronic obstructive pulmonary disease. Deep venous thrombosis was identified in 58% of patients, and pulmonary embolism was the direct cause of death in 4 patients. PMCT revealed severe bilateral lung consolidation, and histopathology showed diffuse alveolar damage in 8 patients. SARS-CoV-2 RNA was detected in all lungs and in the pharynx of 9 patients, with viremia in 6 patients. The study highlights the high incidence of thromboembolic events and suggests an important role for COVID-19–induced coagulopathy. Further research is needed to understand the molecular mechanisms and clinical incidence of COVID-19–related death and to explore therapeutic interventions.This prospective cohort study investigates the causes of death and pathologic features in patients with COVID-19 through complete autopsies, including postmortem computed tomography (PMCT), histopathologic analysis, and virologic testing. The study included 12 consecutive COVID-19–positive deaths, with a median age of 73 years and a male predominance. Common comorbidities included coronary heart disease and asthma or chronic obstructive pulmonary disease. Deep venous thrombosis was identified in 58% of patients, and pulmonary embolism was the direct cause of death in 4 patients. PMCT revealed severe bilateral lung consolidation, and histopathology showed diffuse alveolar damage in 8 patients. SARS-CoV-2 RNA was detected in all lungs and in the pharynx of 9 patients, with viremia in 6 patients. The study highlights the high incidence of thromboembolic events and suggests an important role for COVID-19–induced coagulopathy. Further research is needed to understand the molecular mechanisms and clinical incidence of COVID-19–related death and to explore therapeutic interventions.
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