Arterial thrombosis, the unfairly forgotten actor in COVID-19: a case series

Abstract Background. - It is known that patients with COVID-19 are at increased risk of thrombosis. Although COVID-19 infection primarily affects the lower respiratory tract system, emerging reports suggest direct and indirect cardiovascular complications. However, the key mechanisms under thrombosis development at great arterial vessels are still unclear.Case presentation. – We report the cases of 4 patients who were admitted to our hospital and suffered from arterial thrombotic complications. All of them were older than 60 years and only 1 did not have cardiovascular risk factors. It should be noted that days prior to the diagnosis of arterial thrombosis, 3 of the 4 patients were under anticoagulant treatment. It is also interesting that in contrast to already known typical microvascular locations, our patients suffered from large arterial vessels thrombosis. Furthermore, none of them would present with severe respiratory symptoms. Conclusions. – The underlying mechanism of COVID-19-associated arterial thrombosis remains unclear and might be independent of the cytokine storm that occurs in patients with COVID-19-associated venous thrombosis. Also, the role of anti-platelets agents as prophylactic treatment in high-risk patients remains unclear. Multicenter clinical trials are necessary to clarify these issues.