Background Coronavirus disease (COVID-19) pneumonitis associated with severe respiratory failure has a high mortality rate. Based on recent reports, the most severely ill patients present with coagulopathy, and disseminated intravascular coagulation (DIC)-like massive intravascular clot formation is frequently observed. Coagulopathy has emerged as a significant contributor to thrombotic complications. Although recommendations have been made for anticoagulant use for COVID-19, no guidelines have been specified. Case summary We describe four cases of critical COVID-19 with thrombosis detected by enhanced CT scan. The CT findings of all cases demonstrated typical findings of COVID-19 and pulmonary embolism or deep venous thrombus without critical exacerbation. Two patients died of respiratory failure due to COVID-19. Discussion Previous reports have suggested coagulopathy with thrombotic signs as the main pathological feature of COVID-19, but no previous reports have focused on coagulopathy evaluated by whole-body enhanced CT scan. Changes in hemostatic biomarkers, represented by an increase in D-dimer and fibrin/fibrinogen degradation products, indicated that the essence of coagulopathy was massive fibrin formation. Although there were no clinical symptoms related to their prognosis, critical COVID-19-induced systemic thrombus formation was observed. Conclusions Therapeutic dose anticoagulants should be considered for critical COVID-19 because of induced coagulopathy, and aggressive follow-up by whole body enhanced CT scan for systemic venous thromboembolism (VTE) is necessary. Supplementary Information The online version contains supplementary material available at 10.1186/s12959-021-00280-z.
【저자키워드】 COVID-19, D-dimer, Venous Thromboembolism, Coagulopathy, Anticoagulant, Whole-body CT scan, 【초록키워드】 Biomarkers, Respiratory failure, thrombosis, Prognosis, Thrombotic complications, severe respiratory failure, CT scan, Thrombus, Follow-up, Degradation, disease, change, Critical, Disseminated intravascular coagulation, VTE, therapeutic dose, thrombus formation, supplementary material, clinical symptom, thrombotic, high mortality rate, recommendation, venous, died, indicated, evaluated, Two patient, demonstrated, suggested, increase in, CT finding, severely ill patient, 【제목키워드】 Pneumonia, CT scan, Critical, case sery,