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COVID-19 hastalarında derin ven trombozu ile seri toraks bilgisayarlı tomografi şiddet skorları arasındaki ilişkisi

Year 2025, Volume: 30 Issue: 2, 197 - 210, 29.05.2025

Burcu Akman , Ahmet Turan Kaya , Mustafa Çapraz , Mustafa Cihangiroğlu

https://doi.org/10.21673/anadoluklin.1493434

Abstract

Amaç: COVID-19 hastalarında alt ekstremite venlerinde derin ven trombozu (DVT) için risk faktörlerini ve DVT ile toraks Bilgisayarlı Tomografi şiddet skorları (BT-ŞS) arasındaki ilişkiyi değerlendirmeyi amaçladık. Bildiğimiz kadarıyla, çalışmamız COVID-19 hastalarında DVT oluşumu ile seri toraks BT-ŞS arasındaki ilişkiyi araştıran ilk çalışmadır.

Yöntemler: Çalışmamızda, retrospektif olarak hastanemize başvuran 131 COVID-19 hastayı (≥18 yaş) analiz ettik. İki radyolog toraks BT taramalarını inceledi ve görsel bir skorlama sistemi kullanarak BT-ŞS’ nı hesapladı. DVT için alt ekstremite damarlarının renkli Doppler ultrasonları yapıldı. Klinik olarak pulmoner emboli (PE) olduğundan şüphelenilen hastalara BT Pulmoner Anjiyografiler (BTPA) uygulandı.

Bulgular: Çalışmamıza toplam 131 hasta dahil edildi. Hastaların 71/131’i (%54,2) erkekti. 18/131 (%13,7) hasta yoğun bakımda tedavi gördü ve 18 (%13,7) hasta öldü. 21/131 hastanın alt ekstremitelerinde DVT (%16) vardı. 44/131 (%33,6) hastaya toraks BTA yapıldı ve 10/44 (%22,7) hastada PE saptandı. DVT’li hastalarda PE sıklığı anlamlı olarak yüksekti (p= 0.009). DVT oluşumu, yüksek ilk göğüs BT-ŞS’si ile anlamlı şekilde ilişkiliydi (p=0.002). Ancak DVT ile ikinci ve üçüncü BT-ŞS arasında ilişki yoktu. Artmış serum D-Dimer, CRP ve fibrinojen seviyeleri ile DVT gelişimi arasında anlamlı ilişkiler bulundu (p<0.001; p=0.014; p=0.031).

Sonuç: Başvuru sırasında çekilen toraks BT’de yaygın akciğer tutulumu olan COVID-19 hastalarında DVT riski daha yüksektir.

Keywords

Bilgisayarlı tomografi anjiografi COVID-19 doppler ultrason venöz tromboz

References

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  • Rauch A, Dupont A, Goutay J, et al. Endotheliopathy Is Induced by Plasma From Critically Ill Patients and Associated With Organ Failure in Severe COVID-19. Circulation. 2020;142(19):1881-4.
  • Voicu S, Delrue M, Chousterman BG, et al. Imbalance between procoagulant factors and natural coagulation inhibitors contributes to hypercoagulability in the critically ill COVID-19 patient: clinical implications. Eur Rev Med Pharmacol Sci. 2020;24(17):9161-8.
  • Salabei JK, Fishman TJ, Asnake ZT, Ali A, Iyer UG. COVID-19 Coagulopathy: Current knowledge and guidelines on anticoagulation. Heart Lung. 2021;50(2):357-60.
  • Wu MA, Colombo R, Arquati M, et al. Clinical-radiological correlations in COVID-19-related venous thromboembolism: Preliminary results from a multidisciplinary study. Int J Clin Pract. 2021;75(9):e14370.
  • Thomas MR, Scully M. Clinical features of thrombosis and bleeding in COVID-19. Blood. 2022;140(3):184-95.
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  • Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145-7.
  • Goeijenbier M, van Wissen M, van de Weg C, et al. Review: Viral infections and mechanisms of thrombosis and bleeding. J Med Virol. 2012;84(10):1680-96.
  • Han H, Yang L, Liu R, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med. 2020;58(7):1116-20.
  • Terpos E, Ntanasis-Stathopoulos I, Elalamy I, et al. Hematological findings and complications of COVID-19. Am J Hematol. 2020;95(7):834-47.
  • Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020;18(6):1421-4.
  • Trigonis RA, Holt DB, Yuan R, et al. Incidence of Venous Thromboembolism in Critically Ill Coronavirus Disease 2019 Patients Receiving Prophylactic Anticoagulation. Crit Care Med. 2020;48(9):e805-8.
  • Léonard-Lorant I, Delabranche X, Séverac F, et al. Acute Pulmonary Embolism in Patients with COVID-19 at CT Angiography and Relationship to d-Dimer Levels. Radiology. 2020;296(3):E189-91.
  • Needleman L, Cronan JJ, Lilly MP, et al. Ultrasound for Lower Extremity Deep Venous Thrombosis: Multidisciplinary Recommendations From the Society of Radiologists in Ultrasound Consensus Conference. Circulation. 2018;137(14):1505-15.
  • Li JY, Wang HF, Yin P, et al. Clinical characteristics and risk factors for symptomatic venous thromboembolism in hospitalized COVID-19 patients: A multicenter retrospective study. J Thromb Haemost. 2021;19(4):1038-48.
  • Elmokadem AH, Mounir AM, Ramadan ZA, Elsedeiq M, Saleh GA. Comparison of chest CT severity scoring systems for COVID-19. Eur Radiol. 2022;32(5):3501-12.
  • Cronan JJ, Dorfman GS, Scola FH, Schepps B, Alexander J. Deep venous thrombosis: US assessment using vein compression. Radiology. 1987;162(1 Pt 1):191-4.
  • The Lancet Haematology. COVID-19 coagulopathy: an evolving story. Lancet Haematol. 2020;7(6):e425.
  • Bikdeli B, Madhavan MV, Jimenez D, 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.
  • Zhai Z, Li C, Chen Y, et al. Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines. Thromb Haemost. 2020;120(6):937-48.
  • Suh YJ, Hong H, Ohana M, et al. Pulmonary Embolism and Deep Vein Thrombosis in COVID-19: A Systematic Review and Meta-Analysis. Radiology. 2021;298(2):E70-80.
  • Voicu S, Bonnin P, Malissin I, et al. Characteristics of deep vein thrombosis in the critically ill COVID-19 patient - an observational cohort study with Doppler ultrasound measurements. Eur Rev Med Pharmacol Sci. 2022;26(2):686-94.
  • Goldhaber SZ, Piazza G. Pulmonary Embolism and Deep Vein Thrombosis. Cardiovasc Ther A Companion to Braunwald’s Hear Dis Fourth Ed. 2012;19(5):580–95.
  • Jiménez D, García-Sanchez A, Rali P, et al. Incidence of VTE and Bleeding Among Hospitalized Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis. Chest. 2021;159(3):1182-96.
  • Edler C, Schröder AS, Aepfelbacher M, 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):1275-1284.
  • Zhou S, Chen C, Hu Y, Lv W, Ai T, Xia L. Chest CT imaging features and severity scores as biomarkers for prognostic prediction in patients with COVID-19. Ann Transl Med. 2020;8(21):1449.
  • Francone M, Iafrate F, Masci GM, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol. 2020;30(12):6808-17.
  • Espallargas I, Rodríguez Sevilla JJ, Rodríguez Chiaradía DA, et al. CT imaging of pulmonary embolism in patients with COVID-19 pneumonia: a retrospective analysis. Eur Radiol. 2021;31(4):1915-22.
  • Fang C, Garzillo G, Batohi B, et al. Extent of pulmonary thromboembolic disease in patients with COVID-19 on CT: relationship with pulmonary parenchymal disease. Clin Radiol. 2020;75(10):780-8.
  • Yu Y, Tu J, Lei B, et al. Incidence and Risk Factors of Deep Vein Thrombosis in Hospitalized COVID-19 Patients. Clin Appl Thromb Hemost. 2020;26:1076029620953217.
  • Dujardin RWG, Hilderink BN, Haksteen WE, et al. Biomarkers for the prediction of venous thromboembolism in critically ill COVID-19 patients. Thromb Res. 2020;196:308-12.
  • Middeldorp S, Coppens M, van Haaps TF, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 2020;18(8):1995-2002.
  • Barnes GD, Burnett A, Allen A, et al. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J Thromb Thrombolysis. 2020;50(1):72-81.
  • Kirshblum SC, DeLauter G, Eren F, et al. Screening for Deep Vein Thrombosis in Persons With COVID-19 Upon Admission to an Inpatient Rehabilitation Hospital. Am J Phys Med Rehabil. 2021;100(5):419-23.
  • Ahuja N, Bhinder J, Nguyen J, et al. Venous thromboembolism in patients with COVID-19 infection: risk factors, prevention, and management. Semin Vasc Surg. 2021;34(3):101-16.
  • Lippi G, Favaloro EJ. D-dimer is Associated with Severity of Coronavirus Disease 2019: A Pooled Analysis. Thromb Haemost. 2020;120(5):876-8.
  • Thondapu V, Montes D, Rosovsky R, et al. Venous thrombosis, thromboembolism, biomarkers of inflammation, and coagulation in coronavirus disease 2019. J Vasc Surg Venous Lymphat Disord. 2021;9(4):835-44.
  • Al-Samkari H, Karp Leaf RS, Dzik WH, et al. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood. 2020;136(4):489-500.
  • Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18(5):1094-9.
  • Zhou Y, Yang Q, Chi J, et al. Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: A systematic review and meta-analysis. Int J Infect Dis. 2020;99:47-56.
  • Xiong X, Chi J, Gao Q. Prevalence and risk factors of thrombotic events on patients with COVID-19: a systematic review and meta-analysis. Thromb J. 2021;19(1):32.
  • Koleilat I, Galen B, Choinski K, et al. Clinical characteristics of acute lower extremity deep venous thrombosis diagnosed by duplex in patients hospitalized for coronavirus disease 2019. J Vasc Surg Venous Lymphat Disord. 2021;9(1):36-46.
  • Chang H, Rockman CB, Jacobowitz GR, et al. Deep vein thrombosis in hospitalized patients with coronavirus disease 2019. J Vasc Surg Venous Lymphat Disord. 2021;9(3):597-604.

Relationship between deep vein thrombosis and serial chest computerized tomography severity scores in COVID-19 patients

Year 2025, Volume: 30 Issue: 2, 197 - 210, 29.05.2025

Burcu Akman , Ahmet Turan Kaya , Mustafa Çapraz , Mustafa Cihangiroğlu

https://doi.org/10.21673/anadoluklin.1493434

Abstract

Aim: We aimed to evaluate risk factors for deep vein thrombosis (DVT) in the lower extremities veins in COVID-19 patients and the relationship between DVT and chest Computed Tomography severity scores (CT-SS). To our knowledge, our study is the first to investigate the relationship between the occurrence of DVT and serial chest CT-SS in COVID-19 patients.

Methods: We retrospectively analyzed 131 COVID-19 patients (≥18 years) admitted to our hospital. Two radiologists examined chest CT scans and calculated CT-SS using a visual scoring system. Color Doppler ultrasounds of lower extremity veins were performed for DVT. CT Pulmonary Angiographies (CTPA) were performed on patients clinically suspected of pulmonary embolism (PE).

Results: A total of 131 patients were included in our study. 71/131 (54.2%) of the patients were male. 18/131 (13.7%) patients were treated in ICU, and 18 (13.7%) patients died. 21/131 (16%) patients had DVT in their lower extremities. Chest CTA was performed in 44/131 (33.6%) patients, and PE was detected in 10/44 patients (22.7%). PE was considerably more common in patients with DVT (p = 0.009). The occurrence of DVT was significantly associated with high first chest CT-SS (p=0.002). However, there was no association between the DVT and the second and third CT-SS. Significant associations were found between the development of DVT with elevated serum D-Dimer, CRP, and fibrinogen levels (p<0.001; p=0.014; p=0.031).

Conclusion: The risk of DVT is higher in COVID-19 patients with diffuse pulmonary involvement on chest CT at admission.

Keywords

Computed tomography angiography COVID-19 doppler ultrasonography venous thrombosis

Ethical Statement

This study was approved by the Ethical Committee of Amasya University Faculty of Medicine and was conducted according to the Declaration of Helsinki and Good Clinical Practice (approval number:62, 06 May 2021) and the requirement for informed consent was waived.

Supporting Institution

Yok

References

  • Zhang J, Meng G, Li W, et al. Relationship of chest CT score with clinical characteristics of 108 patients hospitalized with COVID-19 in Wuhan, China. Respir Res. 2020;21(1):180.
  • Ding X, Xu J, Zhou J, Long Q. Chest CT findings of COVID-19 pneumonia by duration of symptoms. Eur J Radiol. 2020;127:109009.
  • Pan F, Ye T, Sun P, et al. Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19). Radiology. 2020;295(3):715-721.
  • Iba T, Levy JH, Connors JM, Warkentin TE, Thachil J, Levi M. The unique characteristics of COVID-19 coagulopathy. Crit Care. 2020;24(1):360.
  • Rauch A, Dupont A, Goutay J, et al. Endotheliopathy Is Induced by Plasma From Critically Ill Patients and Associated With Organ Failure in Severe COVID-19. Circulation. 2020;142(19):1881-4.
  • Voicu S, Delrue M, Chousterman BG, et al. Imbalance between procoagulant factors and natural coagulation inhibitors contributes to hypercoagulability in the critically ill COVID-19 patient: clinical implications. Eur Rev Med Pharmacol Sci. 2020;24(17):9161-8.
  • Salabei JK, Fishman TJ, Asnake ZT, Ali A, Iyer UG. COVID-19 Coagulopathy: Current knowledge and guidelines on anticoagulation. Heart Lung. 2021;50(2):357-60.
  • Wu MA, Colombo R, Arquati M, et al. Clinical-radiological correlations in COVID-19-related venous thromboembolism: Preliminary results from a multidisciplinary study. Int J Clin Pract. 2021;75(9):e14370.
  • Thomas MR, Scully M. Clinical features of thrombosis and bleeding in COVID-19. Blood. 2022;140(3):184-95.
  • Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475–81.
  • Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145-7.
  • Goeijenbier M, van Wissen M, van de Weg C, et al. Review: Viral infections and mechanisms of thrombosis and bleeding. J Med Virol. 2012;84(10):1680-96.
  • Han H, Yang L, Liu R, et al. Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med. 2020;58(7):1116-20.
  • Terpos E, Ntanasis-Stathopoulos I, Elalamy I, et al. Hematological findings and complications of COVID-19. Am J Hematol. 2020;95(7):834-47.
  • Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost. 2020;18(6):1421-4.
  • Trigonis RA, Holt DB, Yuan R, et al. Incidence of Venous Thromboembolism in Critically Ill Coronavirus Disease 2019 Patients Receiving Prophylactic Anticoagulation. Crit Care Med. 2020;48(9):e805-8.
  • Léonard-Lorant I, Delabranche X, Séverac F, et al. Acute Pulmonary Embolism in Patients with COVID-19 at CT Angiography and Relationship to d-Dimer Levels. Radiology. 2020;296(3):E189-91.
  • Needleman L, Cronan JJ, Lilly MP, et al. Ultrasound for Lower Extremity Deep Venous Thrombosis: Multidisciplinary Recommendations From the Society of Radiologists in Ultrasound Consensus Conference. Circulation. 2018;137(14):1505-15.
  • Li JY, Wang HF, Yin P, et al. Clinical characteristics and risk factors for symptomatic venous thromboembolism in hospitalized COVID-19 patients: A multicenter retrospective study. J Thromb Haemost. 2021;19(4):1038-48.
  • Elmokadem AH, Mounir AM, Ramadan ZA, Elsedeiq M, Saleh GA. Comparison of chest CT severity scoring systems for COVID-19. Eur Radiol. 2022;32(5):3501-12.
  • Cronan JJ, Dorfman GS, Scola FH, Schepps B, Alexander J. Deep venous thrombosis: US assessment using vein compression. Radiology. 1987;162(1 Pt 1):191-4.
  • The Lancet Haematology. COVID-19 coagulopathy: an evolving story. Lancet Haematol. 2020;7(6):e425.
  • Bikdeli B, Madhavan MV, Jimenez D, 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.
  • Zhai Z, Li C, Chen Y, et al. Prevention and Treatment of Venous Thromboembolism Associated with Coronavirus Disease 2019 Infection: A Consensus Statement before Guidelines. Thromb Haemost. 2020;120(6):937-48.
  • Suh YJ, Hong H, Ohana M, et al. Pulmonary Embolism and Deep Vein Thrombosis in COVID-19: A Systematic Review and Meta-Analysis. Radiology. 2021;298(2):E70-80.
  • Voicu S, Bonnin P, Malissin I, et al. Characteristics of deep vein thrombosis in the critically ill COVID-19 patient - an observational cohort study with Doppler ultrasound measurements. Eur Rev Med Pharmacol Sci. 2022;26(2):686-94.
  • Goldhaber SZ, Piazza G. Pulmonary Embolism and Deep Vein Thrombosis. Cardiovasc Ther A Companion to Braunwald’s Hear Dis Fourth Ed. 2012;19(5):580–95.
  • Jiménez D, García-Sanchez A, Rali P, et al. Incidence of VTE and Bleeding Among Hospitalized Patients With Coronavirus Disease 2019: A Systematic Review and Meta-analysis. Chest. 2021;159(3):1182-96.
  • Edler C, Schröder AS, Aepfelbacher M, 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):1275-1284.
  • Zhou S, Chen C, Hu Y, Lv W, Ai T, Xia L. Chest CT imaging features and severity scores as biomarkers for prognostic prediction in patients with COVID-19. Ann Transl Med. 2020;8(21):1449.
  • Francone M, Iafrate F, Masci GM, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol. 2020;30(12):6808-17.
  • Espallargas I, Rodríguez Sevilla JJ, Rodríguez Chiaradía DA, et al. CT imaging of pulmonary embolism in patients with COVID-19 pneumonia: a retrospective analysis. Eur Radiol. 2021;31(4):1915-22.
  • Fang C, Garzillo G, Batohi B, et al. Extent of pulmonary thromboembolic disease in patients with COVID-19 on CT: relationship with pulmonary parenchymal disease. Clin Radiol. 2020;75(10):780-8.
  • Yu Y, Tu J, Lei B, et al. Incidence and Risk Factors of Deep Vein Thrombosis in Hospitalized COVID-19 Patients. Clin Appl Thromb Hemost. 2020;26:1076029620953217.
  • Dujardin RWG, Hilderink BN, Haksteen WE, et al. Biomarkers for the prediction of venous thromboembolism in critically ill COVID-19 patients. Thromb Res. 2020;196:308-12.
  • Middeldorp S, Coppens M, van Haaps TF, et al. Incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost. 2020;18(8):1995-2002.
  • Barnes GD, Burnett A, Allen A, et al. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J Thromb Thrombolysis. 2020;50(1):72-81.
  • Kirshblum SC, DeLauter G, Eren F, et al. Screening for Deep Vein Thrombosis in Persons With COVID-19 Upon Admission to an Inpatient Rehabilitation Hospital. Am J Phys Med Rehabil. 2021;100(5):419-23.
  • Ahuja N, Bhinder J, Nguyen J, et al. Venous thromboembolism in patients with COVID-19 infection: risk factors, prevention, and management. Semin Vasc Surg. 2021;34(3):101-16.
  • Lippi G, Favaloro EJ. D-dimer is Associated with Severity of Coronavirus Disease 2019: A Pooled Analysis. Thromb Haemost. 2020;120(5):876-8.
  • Thondapu V, Montes D, Rosovsky R, et al. Venous thrombosis, thromboembolism, biomarkers of inflammation, and coagulation in coronavirus disease 2019. J Vasc Surg Venous Lymphat Disord. 2021;9(4):835-44.
  • Al-Samkari H, Karp Leaf RS, Dzik WH, et al. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood. 2020;136(4):489-500.
  • Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18(5):1094-9.
  • Zhou Y, Yang Q, Chi J, et al. Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: A systematic review and meta-analysis. Int J Infect Dis. 2020;99:47-56.
  • Xiong X, Chi J, Gao Q. Prevalence and risk factors of thrombotic events on patients with COVID-19: a systematic review and meta-analysis. Thromb J. 2021;19(1):32.
  • Koleilat I, Galen B, Choinski K, et al. Clinical characteristics of acute lower extremity deep venous thrombosis diagnosed by duplex in patients hospitalized for coronavirus disease 2019. J Vasc Surg Venous Lymphat Disord. 2021;9(1):36-46.
  • Chang H, Rockman CB, Jacobowitz GR, et al. Deep vein thrombosis in hospitalized patients with coronavirus disease 2019. J Vasc Surg Venous Lymphat Disord. 2021;9(3):597-604.
There are 47 citations in total.

Details

Primary Language English
Subjects Radiology and Organ Imaging
Journal Section ORIGINAL ARTICLE
Authors

Burcu Akman 0000-0002-1067-9008

Ahmet Turan Kaya 0000-0001-9803-453X

Mustafa Çapraz 0000-0001-9586-6509

Mustafa Cihangiroğlu 0000-0001-6148-5142

Publication Date May 29, 2025
Submission Date May 31, 2024
Acceptance Date November 11, 2024
Published in Issue Year 2025 Volume: 30 Issue: 2

Cite

Vancouver Akman B, Kaya AT, Çapraz M, Cihangiroğlu M. Relationship between deep vein thrombosis and serial chest computerized tomography severity scores in COVID-19 patients. Anatolian Clin. 2025;30(2):197-210.
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