{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:55:58Z","timestamp":1760151358795,"version":"build-2065373602"},"reference-count":29,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T00:00:00Z","timestamp":1646956800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Clinical signs and symptoms of COVID-19 varied from asymptomatic forms to severe, life-threatening conditions that required treatment in intensive care units. These severe forms of illness are connected with a hypercoagulable state due to excessive inflammation, hypoxia, immobilisation, and altered angiotensin-converting enzyme 2 (ACE-2). In total, 17 COVID-19 positive patients were diagnosed with peripheral arterial thrombosis (AT), 13 of them had COVID-19 pneumonia. Laboratory findings in patients with X-ray confirmed pneumonia showed a four times higher neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP) and three times higher lactate dehydrogenase level (LDH) than patients without confirmed pneumonia. Patients with pneumonia had significantly more bilateral occlusions of the lower extremities and a significantly higher percentage with complete occlusion of the arteries than patients without pneumonia. The rate of limb loss was 35.3%. They were all from the group with COVID-19 pneumonia. Ten out of thirteen patients with pneumonia died due to acute respiratory distress syndrome (ARDS). All patients without pneumonia were discharged from the hospital. The aim of this retrospective study was to report the incidence of arterial thrombosis of lower extremities and their complications in the acute phase of the infection among COVID-19 patients admitted to the hospital for treatment.<\/jats:p>","DOI":"10.3390\/jcm11061538","type":"journal-article","created":{"date-parts":[[2022,3,11]],"date-time":"2022-03-11T12:58:36Z","timestamp":1647003516000},"page":"1538","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Acute Arterial Thrombosis of Lower Extremities in COVID-19 Patients"],"prefix":"10.3390","volume":"11","author":[{"given":"Robert","family":"Glavinic","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, University Hospital of Split, Soltanska 1, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ljiljana","family":"Marcic","sequence":"additional","affiliation":[{"name":"Department of Radiology, Policlinic Medicol, Soltanska 1, 21000 Split, Croatia"},{"name":"University Department of Health Studies, University of Split, Rudera Boskovica 35, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4005-5394","authenticated-orcid":false,"given":"Stipe","family":"Dumancic","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8878-7164","authenticated-orcid":false,"given":"Mirela","family":"Pavicic Ivelja","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University Hospital of Split, Soltanska 1, 21000 Split, Croatia"},{"name":"University Department of Health Studies, University of Split, Rudera Boskovica 35, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irena","family":"Jeli\u010di\u0107","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, University Hospital of Split, Soltanska 1, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2598-9009","authenticated-orcid":false,"given":"Danijela","family":"Kalibovic Govorko","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia"},{"name":"Department of Maxillofacial Surgery, University Hospital of Split, Soltanska 1, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivana","family":"Medvedec Miki\u0107","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia"},{"name":"Department of Maxillofacial Surgery, University Hospital of Split, Soltanska 1, 21000 Split, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"Guan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1001\/jamacardio.2020.1105","article-title":"Association of Coronavirus Disease 2019 (COVID-19) with myocardial injury and mortality","volume":"5","author":"Bonow","year":"2020","journal-title":"JAMA Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"104362","DOI":"10.1016\/j.jcv.2020.104362","article-title":"Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past","volume":"127","author":"Giannis","year":"2020","journal-title":"J. Clin. Virol."},{"key":"ref_4","first-page":"e7355","article-title":"Coronavirus (COVID-19): A review of clinical features, diagnosis, and treatment","volume":"12","author":"Hassan","year":"2020","journal-title":"Cureus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"m1091","DOI":"10.1136\/bmj.m1091","article-title":"Clinical characteristics of 113 deceased patients with coronavirus disease 2019: A retrospective study","volume":"368","author":"Chen","year":"2020","journal-title":"BMJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1111\/jth.14768","article-title":"Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia","volume":"18","author":"Tang","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1016\/S0140-6736(20)30628-0","article-title":"COVID-19: Consider cytokine storm syndromes and immunosuppression","volume":"395","author":"Mehta","year":"2020","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"142","DOI":"10.3389\/fped.2018.00142","article-title":"The role of inflammation in venous thromboembolism","volume":"6","author":"Branchford","year":"2018","journal-title":"Front. Pediatr."},{"key":"ref_10","first-page":"662","article-title":"Relation of neutrophil-to-lymphocyte ratio with the presence and complexity of coronary artery disease: An observational study","volume":"13","author":"Tasal","year":"2013","journal-title":"Anadolu Kardiyol. Derg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1055\/s-0040-1714350","article-title":"COVID-19-related severe hypercoagulability in patients admitted to intensive care unit for acute respiratory failure","volume":"120","author":"Spiezia","year":"2020","journal-title":"Thromb. Haemost."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1055\/s-0040-1709650","article-title":"D-dimer is associated with severity of coronavirus disease 2019: A pooled analysis","volume":"120","author":"Lippi","year":"2020","journal-title":"Thromb. Haemost."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1515\/cclm-2020-0369","article-title":"Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): A meta-analysis","volume":"58","author":"Henry","year":"2020","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1177\/1538574420954301","article-title":"Bilateral Acute Lower Limb Ischemia Secondary to COVID-19","volume":"55","author":"Veerasuri","year":"2021","journal-title":"Vasc. Endovasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1136\/bmj.320.7237.764","article-title":"ABC of arterial and venous disease: Acute limb ischaemia","volume":"18","author":"Callum","year":"2000","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1016\/j.jvs.2006.12.037","article-title":"Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II)","volume":"45","author":"Norgren","year":"2007","journal-title":"J. Vasc. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1097\/01.sla.0000086663.49670.d1","article-title":"A national and single institutional experience in the contemporary treatment of acute lower extremity ischemia","volume":"238","author":"Eliason","year":"2003","journal-title":"Ann. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.clinimag.2020.11.023","article-title":"Peripheral arterial occlusion due to COVID-19: CT angiography findings of nine patients","volume":"73","author":"Ogawa","year":"2021","journal-title":"Clin. Imaging"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.tcm.2020.12.004","article-title":"COVID-19 and thrombosis: From bench to bedside","volume":"31","author":"Ali","year":"2021","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1515\/cclm-2020-0188","article-title":"Prominent changes in blood coagulation of patients with SARS-CoV-2 infection","volume":"58","author":"Han","year":"2020","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1864","DOI":"10.1016\/j.jvs.2020.04.483","article-title":"Acute limb ischemia in patients with COVID-19 pneumonia","volume":"72","author":"Bellosta","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ghasemi, M., Umeton, R.P., Keyhanian, K., Mohit, B., Rahimian, N., Eshaghhosseiny, N., and Davoudi, V. (2021). SARS-CoV-2 and Acute Cerebrovascular Events: An Overview. J. Clin. Med., 10.","DOI":"10.3390\/jcm10153349"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00011-020-01401-6","article-title":"The coagulopathy, endotheliopathy, and vasculitis of COVID-19","volume":"69","author":"Iba","year":"2020","journal-title":"Inflamm. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1007\/s11239-020-02176-7","article-title":"Incidence and consequences of systemic arterial thrombotic events in COVID-19 patients","volume":"50","author":"Cantador","year":"2020","journal-title":"J. Thromb. Thrombolysis"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"21519","DOI":"10.1038\/s41598-021-00927-x","article-title":"Prognostic value of neutrophil-to-lymphocyte ratio in COVID-19 compared with Influenza and respiratory syncytial virus infection","volume":"11","author":"Prozan","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1186\/s12967-020-02374-0","article-title":"Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage","volume":"18","author":"Liu","year":"2020","journal-title":"J. Transl. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.avsg.2020.08.087","article-title":"Arterial Thrombosis in Coronavirus Disease 2019 Patients: A Rapid Systematic Review","volume":"70","author":"Cheruiyot","year":"2021","journal-title":"Ann. Vasc. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.avsg.2020.08.085","article-title":"Acute Arterial Thromboembolism in Patients with COVID-19 in the New York City Area","volume":"70","author":"Etkin","year":"2021","journal-title":"Ann. Vasc. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1016\/j.radcr.2021.04.033","article-title":"COVID-19 and arterial thrombosis: Report of 2 cases","volume":"16","author":"Singh","year":"2021","journal-title":"Radiol. Case Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/6\/1538\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:34:48Z","timestamp":1760135688000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/6\/1538"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,11]]},"references-count":29,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["jcm11061538"],"URL":"https:\/\/doi.org\/10.3390\/jcm11061538","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2022,3,11]]}}}