In a series autopsies performed on patients who died due to coronavirus disease 2019 (COVID-19)–related complications, thrombosis of multiple organs was a prominent feature, regardless of anticoagulation status, according to a case series published in EClinicalMedicine.

Amy V. Rapkiewicz, MD, chair and autopsy director, department of pathology, at the NYU Long Island School of Medicine in Mineola, and associates presented a series of COVID-19 autopsies with findings in the lungs, heart, kidneys, liver, and bone to add to the information surrounding prothrombotic conditions in patients with COVID-19.

Of the 7 patients included in the case series, 4 patients were women. Patient ages ranged from 44 years to 65 years. Three patients were Hispanic, 3 were White, and 1 was Black. Asystolic arrest at home was reported in 2 patients and 2 patients were reported to be taking aspirin prior to illness.

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Before their COVID-19 diagnosis, none of the patients were taking anticoagulants; however, of the 5 hospitalized patients, all received either therapeutic or prophylactic anticoagulation. In addition, all 5 hospitalized patients were treated with at least 1 dose of azithromycin and hydroxychloroquine, and all were mechanically ventilated.

All patients had platelet-rich thrombi in the microvasculature of the lungs, liver, kidneys, and heart, regardless of their anticoagulation treatment status. Megakaryocytes were also observed in the cardiac microvascular of all patients. Some patients had megakaryocytes in glomeruli, but the highest was noted in the lungs. All cases of megakaryocytes were linked to fibrin microthrombi in cardiac microvasculature.

Assessment of lung parenchyma revealed congestion, diffuse alveolar damage with hyaline membrane formation, and type 2 pneumocyte desquamation in all patients.

Although some autolysis was noted upon renal analysis, acute tubular necrosis, cellular casts, and some pigmented red blood cell casts were seen in all patients.

Upon hepatic tissue analysis, the investigators reported that all patients presented with mild, macrovesicular steatosis without major inflammation or ballooning, which was suggestive of steatohepatitis.

“These findings, in conjunction with extensive platelet-fibrin micro-thrombi detected on specific staining, suggest a profound platelet response in COVID-19 that may be responsible at least in part for multi-organ failure,” the authors noted.

Disclosure: Some of the authors disclosed financial relationships with pharmaceutical companies and medical device manufacturers. For a full list of disclosures, please refer to the original study.


Rapkiewicz AV, Mai X, Carsons SE, at al. Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy n COVID-19: a case series [published online June 25, 2020]. EClinicalMedicine. doi: 10.1016/j.eclinm.2020.100434