{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T10:00:33Z","timestamp":1764842433712,"version":"build-2065373602"},"reference-count":35,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T00:00:00Z","timestamp":1605225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["pathsocjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Pathology CR"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Similar to the influenza A pandemic in 1918\/1919, the new Coronavirus disease 2019 (COVID\u201019) has spread globally. The causes of death in COVID\u201019 are frequently compared to a seasonal influenza outbreak. Complete COVID\u201019 autopsy studies were almost non\u2010existent in the first months of the outbreak and are still rare with respect to the number of deaths. It has been recently reported that capillary microthrombi are significantly more prevalent in patients with COVID\u201019 than in patients with influenza A. To date, the contribution of macrothrombi, i.e. visible thrombi in pulmonary arteries, to the death of patients with influenza A in comparison to COVID\u201019 remains unaddressed. Here, we report autopsy findings in 411 patients who died from the \u2018Spanish\u2019 influenza A pandemic between May 1918 and April 1919 at the University Hospital Zurich, Switzerland. We compare these results with influenza A autopsies from 2009 to 2020, other influenza A autopsy series and all COVID\u201019 autopsies published to date. No descriptions of any macroscopic thromboembolic events were mentioned in influenza A autopsy reports. In 75 published COVID\u201019 autopsies, pulmonary artery thrombosis\/embolism was reported in 36%. The direct comparison of macroscopic autopsy findings suggests a significantly greater degree of grossly visible pulmonary macrothrombi in patients with COVID\u201019 in comparison to influenza A autopsies even though most patients received empiric thromboprophylaxis. This is consistent with the concept of a SARS\u2010related <jats:italic>de novo<\/jats:italic> coagulopathy with generalised <jats:italic>in situ<\/jats:italic> clot formation, which could explain the high incidence of pulmonary thrombosis\/embolism with or without underlying deep vein thrombosis and in the absence of a history of venous thromboembolic events.<\/jats:p>","DOI":"10.1002\/cjp2.189","type":"journal-article","created":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T03:09:05Z","timestamp":1605236945000},"page":"135-143","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Higher prevalence of pulmonary macrothrombi in <scp>SARS\u2010CoV<\/scp>\u20102 than in influenza A: autopsy results from \u2018Spanish flu\u2019 1918\/1919 in Switzerland to Coronavirus disease 2019"],"prefix":"10.1002","volume":"7","author":[{"given":"Nina Maria","family":"Burkhard\u2010Koren","sequence":"first","affiliation":[{"name":"Department of Pathology and Molecular Pathology University Hospital Zurich  Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Haberecker","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Pathology University Hospital Zurich  Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Umberto","family":"Maccio","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Pathology University Hospital Zurich  Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Ruschitzka","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Heart Center, University Hospital Zurich  Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reto A","family":"Schuepbach","sequence":"additional","affiliation":[{"name":"Institute for Intensive Care Medicine University Hospital Zurich  Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4700-1118","authenticated-orcid":false,"given":"Annelies S","family":"Zinkernagel","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases University Hospital Zurich  Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Hardmeier","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Pathology University Hospital Zurich  Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2855-983X","authenticated-orcid":false,"given":"Zsuzsanna","family":"Varga","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Pathology University Hospital Zurich  Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7986-2839","authenticated-orcid":false,"given":"Holger","family":"Moch","sequence":"additional","affiliation":[{"name":"Department of Pathology and Molecular Pathology University Hospital Zurich  Zurich Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,11,13]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2001017"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30211-7"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2020.04.024"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30484-9"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2015432"},{"volume-title":"Die Spanische Grippe in Z\u00fcrich 1918\/19: Erfahrungen aus heutiger Sicht anhand von 970 Sektionen des Pathologischen Institutes Z\u00fcrich","year":"2003","author":"Koren NM","key":"e_1_2_7_7_1"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.7326\/M20-2003"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/M20-2566"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/his.14134"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.carpath.2020.107233"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(20)30243-5"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqaa062"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqaa091"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30937-5"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.carpath.2020.107227"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-020-02881-x"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.047430"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.pathmechdis.3.121806.154316"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1111179108"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1086\/591708"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-019-3750-8"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1309\/AJCP35KOZSAVNQZW"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1827.2011.02751.x"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/1477-9560-5-16"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)13413-7"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.1085952"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa030747"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa030781"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.5858\/2004-128-195-AODDTS"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/path.1440"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20050828"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2011.02473.x"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvsv.2018.08.010"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41577-020-0343-0"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2011400"}],"container-title":["The Journal of Pathology: Clinical Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cjp2.189","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cjp2.189","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/pathsocjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cjp2.189","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T15:20:34Z","timestamp":1760282434000},"score":1,"resource":{"primary":{"URL":"https:\/\/pathsocjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cjp2.189"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,13]]},"references-count":35,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1002\/cjp2.189"],"URL":"https:\/\/doi.org\/10.1002\/cjp2.189","archive":["Portico"],"relation":{},"ISSN":["2056-4538","2056-4538"],"issn-type":[{"type":"print","value":"2056-4538"},{"type":"electronic","value":"2056-4538"}],"subject":[],"published":{"date-parts":[[2020,11,13]]},"assertion":[{"value":"2020-07-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}