PDF(Pubmed)
Abstract：
UNASSIGNED: Venous thromboembolism (VTE) with the prevalence of pulmonary microcirculatory thrombosis is considered a common complication of novel coronavirus disease (COVID-19) that develops despite anticoagulation.
UNASSIGNED: The clinical course of the disease and the autopsy findings of seven deceased patients with verified COVID-19 were analyzed. The chest computed tomography (CT) scan was routinely performed while CT pulmonary angiography and a duplex ultrasound scan (DUS) of the lower limbs were used in cases of suspected VTE. The VTE prophylaxis was administered to all patients with intermediate or therapeutic doses of low-molecular-weight heparin. The histological examination of the lung tissue and other organs was performed with particular attention paid to the pulmonary vasculature.
UNASSIGNED: Venous thromboembolism, including deep vein thrombosis in one patient and pulmonary artery thrombosis in two patients, was confirmed by imaging tests despite anticoagulation. Systemic thrombolysis was performed in two patients with putative and confirmed pulmonary embolism. An autopsy revealed the signs of acute respiratory distress syndrome in all seven patients. Abnormalities of lung vessels were found in all cases and were represented by dystrophy and necrosis in the endothelium and muscle fibers, and by infiltration by plasmatic cells, neutrophils, and lymphocytes. Multiple clots of variable maturity were observed. All those changes developed despite anticoagulation and were preserved after systemic thrombolysis.
UNASSIGNED: Inflammatory and prothrombotic changes in the arterial wall in parallel with the lack of lung perfusion may cause diffuse arterial thrombosis in the lungs. This background may be responsible for the low response to systemic anticoagulation and thrombolysis in severe forms of COVID-19.
UNASSIGNED: The clinical course of the disease and the autopsy findings of seven deceased patients with verified COVID-19 were analyzed. The chest computed tomography (CT) scan was routinely performed while CT pulmonary angiography and a duplex ultrasound scan (DUS) of the lower limbs were used in cases of suspected VTE. The VTE prophylaxis was administered to all patients with intermediate or therapeutic doses of low-molecular-weight heparin. The histological examination of the lung tissue and other organs was performed with particular attention paid to the pulmonary vasculature.
UNASSIGNED: Venous thromboembolism, including deep vein thrombosis in one patient and pulmonary artery thrombosis in two patients, was confirmed by imaging tests despite anticoagulation. Systemic thrombolysis was performed in two patients with putative and confirmed pulmonary embolism. An autopsy revealed the signs of acute respiratory distress syndrome in all seven patients. Abnormalities of lung vessels were found in all cases and were represented by dystrophy and necrosis in the endothelium and muscle fibers, and by infiltration by plasmatic cells, neutrophils, and lymphocytes. Multiple clots of variable maturity were observed. All those changes developed despite anticoagulation and were preserved after systemic thrombolysis.
UNASSIGNED: Inflammatory and prothrombotic changes in the arterial wall in parallel with the lack of lung perfusion may cause diffuse arterial thrombosis in the lungs. This background may be responsible for the low response to systemic anticoagulation and thrombolysis in severe forms of COVID-19.
摘要：
■伴有肺微循环血栓形成的静脉血栓栓塞（VTE）被认为是新型冠状病毒病（COVID-19）的常见并发症，尽管有抗凝作用。
■分析了7例确诊为COVID-19的死亡患者的临床病程和尸检结果。在疑似VTE的情况下，常规进行胸部计算机断层扫描（CT）扫描，而CT肺动脉造影和下肢的双工超声扫描（DUS）。对所有患者使用中等剂量或治疗剂量的低分子量肝素进行VTE预防。进行肺组织和其他器官的组织学检查，特别注意肺脉管系统。
■静脉血栓栓塞，包括一名患者的深静脉血栓形成和两名患者的肺动脉血栓形成，尽管抗凝，但通过影像学检查证实。对两名推定和确诊的肺栓塞患者进行了全身溶栓。尸检显示所有7名患者均有急性呼吸窘迫综合征的迹象。所有病例均发现肺血管异常，表现为内皮和肌纤维营养不良和坏死，通过浆细胞的浸润，中性粒细胞，和淋巴细胞。观察到多个可变成熟度的凝块。尽管抗凝治疗，所有这些变化仍在发展，并在全身溶栓后保留。
■在缺乏肺灌注的同时，动脉壁的炎症和血栓形成前变化可能会导致肺部弥漫性动脉血栓形成。这种背景可能是严重形式的COVID-19对全身抗凝和溶栓反应低的原因。
■分析了7例确诊为COVID-19的死亡患者的临床病程和尸检结果。在疑似VTE的情况下，常规进行胸部计算机断层扫描（CT）扫描，而CT肺动脉造影和下肢的双工超声扫描（DUS）。对所有患者使用中等剂量或治疗剂量的低分子量肝素进行VTE预防。进行肺组织和其他器官的组织学检查，特别注意肺脉管系统。
■静脉血栓栓塞，包括一名患者的深静脉血栓形成和两名患者的肺动脉血栓形成，尽管抗凝，但通过影像学检查证实。对两名推定和确诊的肺栓塞患者进行了全身溶栓。尸检显示所有7名患者均有急性呼吸窘迫综合征的迹象。所有病例均发现肺血管异常，表现为内皮和肌纤维营养不良和坏死，通过浆细胞的浸润，中性粒细胞，和淋巴细胞。观察到多个可变成熟度的凝块。尽管抗凝治疗，所有这些变化仍在发展，并在全身溶栓后保留。
■在缺乏肺灌注的同时，动脉壁的炎症和血栓形成前变化可能会导致肺部弥漫性动脉血栓形成。这种背景可能是严重形式的COVID-19对全身抗凝和溶栓反应低的原因。
