Literature Reviews

doi: 10.25005/2074-0581-2021-23-1-85-94

O. Nematzoda1, A.D. Gaibov2, E.L. Kalmykov3, A.K. Baratov1

1Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Republic of Tajikistan
2Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
3Vascular and Endovascular Surgery Clinic, Helios University Hospital, Wuppertal, Germany

Objective: To study of the features of the course, diagnosis and treatment of acute arterial thrombosis in patients who have undergone or are suffering from COVID-19.

Methods: A search was carried out for research papers published in the PubMed database before February 12, 2021, devoted to various aspects of the COVID-19-related lesions of the arterial system. Search keywords were: arterial thrombosis, COVID-19, SARS-CoV-2, endothelial dysfunction. In total, 373 articles were found in this database on the combination of COVID-19 and thrombotic complications (including arterial and venous). Among them (after excluding venous thrombosis), 54 corresponded to the specified search parameters and were analyzed in the following areas: the incidence of acute peripheral arterial thrombosis in COVID-19, the mechanisms of hemocoagulation changes depending on the effect of coronavirus infection, and modern principles of treatment.

Results: The analysis of literature data has shown that acute arterial obstruction (AOA) rate occurs from 0.39% to 11.1%. According to most studies, the main risk factors for the development of AOA were the male gender, old age and comorbidity. The use of invasive imaging methods for diagnosis of acute arterial thrombosis is limited both due to the severity of the patient’s status, the impossibility of transporting them, and the risk of infection spreading in relatively «safe» areas of other medical facilities. The authors adhere to different approaches, which sometimes do not correspond with the accepted standards and consensus for the treatment of AOA in «non-COVID» patients. However, all researchers agree on the importance and effectiveness of therapeutic anticoagulation and antiplatelet therapy for the arterial thrombosis in COVID-19 patients.

Conclusion: Currently, many aspects of COVID-19-related arterial thrombosis require further study. COVID-19 pandemic has caused enormous damage to all areas of medicine, including the vascular surgery service, causing a decrease in the number of planned vascular operations. COVID-19-related arterial thrombosis is characterized by the enormous effort required to improve treatment outcomes and increase patient survival. Anticoagulation and antiplatelet therapy is the most effective method for both prevention and treatment of patients with arterial thrombosis associated with coronavirus infection.

Keywords: Arterial thrombosis , COVID-19, SARS-CoV-2, epidemiology, diagnostics, anticoagulant therapy, thrombectomy.

Download file:

  1. Xu X, Chen P, Wang J, Feng J, Zhou H, Li X, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci. 2020;63(3):457-60. Available from:
  2. Edler C, Schröder AS, Aepfelbacher M, Fitzek A, Heinemann A, Heinrich F, et al. Dying with SARS-CoV-2 infection – an autopsy study of the first consecutive 80 cases in Hamburg, Germany. Int J Legal Med. 2020;134(4):1275-84. Available from:
  3. Spyropoulos AC, Levy JH, Ageno W, Connors JM, Hunt BJ, Iba T, et al. Scientific and Standardization Committee communication: Clinical guidance on the diagnosis, prevention, and treatment of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 2020;18(8):1859- 65. Available from:
  4. Bai C, Chotirmall SH, Rello J, Alba GA, Ginns LC, Krishnan JA, et al. Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020). Eur Respir Rev. 2020;29(157):200287. Available from: https://
  5. Thachil J, Tang N, Gando S, Falanga A, Cattaneo M, Levi M, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18(5):1023-6. Available from: https://doi. org/10.1111/jth.14810
  6. Muñoz-Rivas N, Abad-Motos A, Mestre-Gómez B, Sierra-Hidalgo F, CortinaCamarero C, Lorente-Ramos RM, et al. Systemic thrombosis in a large cohort of COVID-19 patients despite thromboprophylaxis: A retrospective study. Thromb Res. 2021;199:132-42. Available from: thromres.2020.12.024
  7. McBane RD 2nd. Arterial thrombosis and coronavirus disease 2019. Mayo Clin Proc. 2021;96(2):274-6. Available from: mayocp.2020.12.009
  8. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic character‑ization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565-74.
  9. Smadja DM, Guerin CL, Chocron R, Yatim N, Boussier J, Gendron N, et al. Angiopoietin-2 as a marker of endothelial activation is a good predictor factor for intensive care unit admission of COVID-19 patients. Angiogenesis. 2020;27:1-10. Available from: 6-020-09730-0
  10. Streetley J, Fonseca AV, Turner J, Kiskin NI, Knipe L, Rosenthal PB, Carter T. Stimulated release of intraluminal vesicles from Weibel-Palade bodies. Blood. 2019;133(25):2707-17. Available from: blood-2018-09-874552
  11. Helms J, Tacquard C, Severac F, Leonard-Lorant I, Ohana M, Delabranche X, et al. High risk of thrombosis in patients with severe SARS-CoV-2 infection: A multicenter prospective cohort study. Intensive Care Med. 2020;46(6):1089- 98. Available from: 10.1007/s00134-020-06062-x
  12. Escher R, Breakey N, Lämmle B. ADAMTS13 activity, von Willebrand factor, factor VIII and d-dimers in COVID-19 inpatients. Thromb Res. 2020;192:174- 5. Available from:
  13. Connell NT, Battinelli EM, Connors JM. Coagulopathy of COVID-19 and antiphospholipid antibodies. J Thromb Haemost. 2020. Available from:
  14. Etkin Y, Conway AM, Silpe J, Qato K, Carroccio A, Manvar-Singh P, et al. Acute arterial thromboembolism in patients with COVID-19 in the New York City Area. Ann Vasc Surg. 2021;70:290-4. Available from: https://doi. org/10.1016/j.avsg.2020.08.085
  15. Sánchez JB, Cuipal Alcalde JD, Ramos Isidro R, Luna CZ, Cubas WS, Coaguila Charres A, et al. Acute limb ischemia in a Peruvian cohort infected by COVID-19. Ann Vasc Surg. 2020:S0890-5096(20)31102-X. Available from:
  16. Bellosta R, Luzzani L, Natalini G, Pegorer MA, Attisani L, Cossu LG, et al. Acute limb ischemia in patients with COVID-19 pneumonia. J Vasc Surg. 2020;72(6):1864-72. Available from: jvs.2020.04.483
  17. Indes JE, Koleilat I, Hatch AN, Choinski K, Jones DB, Aldailami H, et al. Early experience with arterial thromboembolic complications in patients with COVID-19. J Vasc Surg. 2021;73(2):381-9.e1. Available from: https://doi. org/10.1016/j.jvs.2020.07.089
  18. Cantador E, Núñez A, Sobrino P, Espejo V, Fabia L, Vela L, et al. Incidence and consequences of systemic arterial thrombotic events in COVID-19 patients. J Thromb Thrombolysis. 2020;50(3):543-7. Available from: https://doi. org/10.1007/s11239-020-02176-7
  19. Kashi M, Jacquin A, Dakhil B, Zaimi R, Mahé E, Tella E, et al. Severe arterial thrombosis associated with COVID-19 infection. Thromb Res. 2020;192:75-7. Available from:
  20. Gomez-Arbelaez D, Ibarra-Sanchez G, Garcia-Gutierrez A, Comanges-Yeboles A, Ansuategui-Vicente M, Gonzalez-Fajardo JA. COVID-19-related aortic thrombosis: A report of four cases. Ann Vasc Surg. 2020;67:10-3. Available from:
  21. Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers D, Kant KM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thromb Res. 2020;191:148-50. Available from: thromres.2020.04.041
  22. Fraissé M, Logre E, Pajot O, Mentec H, Plantefève G, Contou D. Thrombotic and hemorrhagic events in critically ill COVID-19 patients: A French monocenter retrospective study. Crit Care. 2020;24(1):275. Available from:
  23. Mascia D, Kahlberg A, Melloni A, Rinaldi E, Melissano G, Chiesa R. Singlecenter vascular hub experience after 7 weeks of COVID-19 pandemic in Lombardy (Italy). Ann Vasc Surg. 2020;69:90-9. Available from: https://doi. org/10.1016/j.avsg.2020.07.022
  24. Fournier M, Faille D, Dossier A, Mageau A, Nicaise Roland P, Ajzenberg N, et al. Arterial thrombotic events in adult inpatients with COVID-19. Mayo Clin Proc. 2021;96(2):295-303. Available from: mayocp.2020.11.018
  25. de Roquetaillade C, Chousterman BG, Tomasoni D, Zeitouni M, Houdart E, Guedon A, et al. Unusual arterial thrombotic events in COVID-19 patients. Int J Cardiol. 2021;323:281-4. Available from: ijcard.2020.08.103
  26. Bilaloglu S, Aphinyanaphongs Y, Jones S, Iturrate E, Hochman J, Berger JS. Thrombosis in hospitalized patients with COVID-19 in a New York City Health System. JAMA. 2020;324(8):799-801. Available from: https://doi. org/10.1001/jama.2020.13372
  27. Goldman IA, Ye K, Scheinfeld MH. Lower-extremity arterial thrombosis associated with COVID-19 is characterized by greater thrombus burden and increased rate of amputation and death. Radiology. 2020;297(2):E263-E269. Available from:
  28. Mouawad NJ, Woo K, Malgor RD, Wohlauer MV, Johnson AP, Cuff RF, et al. The impact of the COVID-19 pandemic on vascular surgery practice in the United States. J Vasc Surg. 2020:S0741-5214(20)31920-0. Available from:
  29. Lancaster EM, Wu B, Iannuzzi J, Oskowitz A, Gasper W, Vartanian S, et al. Impact of the coronavirus disease 2019 pandemic on an academic vascular practice and a multidisciplinary limb preservation program. J Vasc Surg. 2020;72(6):1850-5. Available from: jvs.2020.08.132
  30. Johnson AP, Wohlauer MV, Mouawad NJ, Malgor RD, Coogan SM, Sheahan MG 3rd, et al. The impact of the COVID-19 pandemic on vascular surgery trainees in the United States. Ann Vasc Surg. 2020:S0890-5096(20)30918-3. Available from:
  31. Veyre F, Poulain-Veyre C, Esparcieux A, Monsarrat N, Aouifi A, Lapeze J, et al. Femoral arterial thrombosis in a young adult after nonsevere COVID-19. Ann Vasc Surg. 2020;69:85-8. Available from: avsg.2020.07.013
  32. Pillai P, Joseph JP, Fadzillah NHM, Mahmod M. COVID-19 and major organ thromboembolism: Manifestations in neurovascular and cardiovascular systems. J Stroke Cerebrovasc Dis. 2021;30(1):105427. Available from:
  33. Ilonzo N, Rao A, Berger K, Phair J, Vouyouka A, Ravin R, et al. Acute thrombotic events as initial presentation of patients with COVID-19 infection. J Vasc Surg Cases Innov Tech. 2020;6(3):381-3. Available from: https://doi. org/10.1016/j.jvscit.2020.05.011
  34. Piazza G, Campia U, Hurwitz S, Snyder JE, Rizzo SM, Pfeferman MB, et al. Registry of arterial and venous thromboembolic complications in patients with COVID-19. J Am Coll Cardiol. 2020;76(18):2060-72. Available from:
  35. Veerasuri S, Kulkarni SR, Wilson WR, Paravastu SCV. Bilateral acute lower limb ischemia secondary to COVID-19. Vasc Endovasc Surg. 2021;55(2):196- 9. Available from:
  36. El Shamy O, Munoz-Casablanca N, Coca S, Sharma S, Lookstein R, Uribarri J. Bilateral renal artery thrombosis in a patient with COVID-19. Kidney Med. 2021;3(1):116-9. Available from: xkme.2020.07.010
  37. Dumitrascu OM, Volod O, Bose S, Wang Y, Biousse V, Lyden PD. Acute ophthalmic artery occlusion in a COVID-19 patient on apixaban. J Stroke Cerebrovasc Dis. 2020;29(8):104982. Available from: trokecerebrovasdis.2020.104982
  38. Madani MH, Leung ANC, Becker HC, Chan FP, Fleischmann D. Aorto-iliac/ right leg arterial thrombosis necessitating limb amputation, pulmonary arterial, intracardiac, and ilio-caval venous thrombosis in a 40-year-old with COVID-19. Clin Imaging. 2021;75:1-4. Available from: https://doi. org/10.1016/j.clinimag.2020.12.036
  39. Azouz E, Yang S, Monnier-Cholley L, Arrivé L. Systemic arterial thrombosis and acute mesenteric ischemia in a patient with COVID-19. Intensive Care Med. 2020;46(7):1464-5. Available from: 020-06079-2
  40. de Barry O, Mekki A, Diffre C, Seror M, El Hajjam M, Carlier RY. Arterial and venous abdominal thrombosis in a 79-year-old woman with COVID-19 pneumonia. Radiol Case Rep. 2020;15(7):1054-7. Available from: https://doi. org/10.1016/j.radcr.2020.04.055
  41. Del Castillo-García S, Minguito-Carazo C, Echarte JC, Rodríguez-Santamarta M, González TB, Seara ST, et al. A case report of arterial and venous thromboembolism in a patient with severe COVID-19 pneumonia. Eur Heart J Case Rep. 2020;4(6):1-6. Available from: ytaa350
  42. Gerotziafas GT, Catalano M, Colgan MP, Pecsvarady Z, Wautrecht JC, Fazeli B, et al. Guidance for the management of patients with vascular disease or cardiovascular risk factors and COVID-19: Position paper from VAS-European Independent Foundation in Angiology/Vascular Medicine. Thromb Haemost. 2020;120(12):1597-628. Available from: https://doi. org/10.1055/s-0040-1715798
  43. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43. Available from:
  44. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. Available from: https://doi. org/10.1016/S0140-6736(20)30566-3
  45. Yang W, Cao Q, Qin L, Wang X, Cheng Z, Pan A, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): A multi-center study in Wenzhou city, Zhejiang, China. J Infect. 2020;80(4):388- 93. Available from:
  46. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. Available from:
  47. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. Available from: 6736(20)30183-5
  48. San Norberto EM, De Haro J, Peña R, Riera L, Fernández-Caballero D, Sesma A, Rodríguez-Cabeza P, et al. Outcomes after vascular surgery procedures in patients with COVID-19 infection: A national multicenter cohort study (COVID-VAS). Ann Vasc Surg. 2021:S0890-5096(21)00054-6. Available from:
  49. Gonzalez-Fajardo JA, Ansuategui M, Romero C, Comanges A, Gómez-Arbeláez D, Ibarra G, Garcia-Gutierrez A. Mortality of COVID-19 patients with vascular thrombotic complications. Med Clin (Engl Ed). 2021;156(3):112-7. Available from:
  50. Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al. COVID-19 and thrombotic or thromboembolic disease: Implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(23):2950-73. Available from: https://doi. org/10.1016/j.jacc.2020.04.031
  51. Shah A, Donovan K, McHugh A, Pandey M, Aaron L, Bradbury CA, et al. Thrombotic and haemorrhagic complications in critically ill patients with COVID-19: A multicentre observational study. Crit Care. 2020;24(1):561. Available from:
  52. Marietta M, Vandelli P, Mighali P, Vicini R, Coluccio V, D’Amico R; COVID-19 HD Study Group. Randomised controlled trial comparing efficacy and safety of high versus low low-molecular weight heparin dosages in hospitalized patients with severe COVID-19 pneumonia and coagulopathy not requiring invasive mechanical ventilation (COVID-19 HD): a structured summary of a study protocol. Trials. 2020;21(1):574. Available from: https://doi. org/10.1186/s13063-020-04475-z
  53. Flumignan RL, Tinôco JDS, Pascoal PI, Areias LL, Cossi MS, Fernandes MI, et al. Prophylactic anticoagulants for people hospitalised with COVID-19. Cochrane Database Syst Rev. 2020;10:CD013739. Available from: https://doi. org/10.1002/14651858.CD013739
  54. Patell R, Chiasakul T, Bauer E, Zwicker JI. Pharmacologic thromboprophylaxis and thrombosis in hospitalized patients with COVID-19: A pooled analysis. Thromb Haemost. 2021;121(1):76-85. Available from: https://doi. org/10.1055/s-0040-1721664

Authors' information:

Nematzoda Okildzhon
Candidate of Medical Sciences, Leading Researcher of the Republican Scientific Center for Cardiovascular Surgery
Researcher ID: F-8729-2018
Scopus ID: 56469644700
ORCID ID: 0000-0001-7602-7611
SPIN: 2408-9107
Author ID: 929575

Gaibov Alidzhon Dzhuraevich
Corresponding Member of National Academy of Sciences of the Tajikistan, Doctor of Medical Sciences, Full Professor, Professor of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
Researcher ID: AAC-9879-2020
Scopus ID: 6602514987
ORCID ID: 0000-0002-3889-368X
SPIN: 5152-0785
Author ID: 293421

Kalmykov Egan Leonidovich
Candidate of Medical Sciences, Vascular Surgeon, Vascular and Endovascular Surgery Clinic, Helios University Hospital
Researcher ID: K-9827-2013
Scopus ID: 36172240400
ORCID ID: 0000-0001-6784-2243
SPIN: 8623-8897
Author ID: 843609

Baratov Alisher Kenjaevich
Candidate of Medical Sciences, Associate Professor, Endovascular Surgeon, Department of Endovascular Surgery, Republican Scientific Center for Cardiovascular Surgery
Researcher ID: AAE-6818-2019
Scopus ID: 8249648700
ORCID ID: 0000-0002-8072-5751
SPIN: 6576-1680
Author ID: 268956

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Nematzoda Okildzhon
Candidate of Medical Sciences, Leading Researcher of the Republican Scientific Center for Cardiovascular Surgery

734003, Republic of Tajikistan, Dushanbe, Sanoi Str., 33

Tel.: +992 (915) 250055