question: We describe three patients with COVID-19 who presented with an acute vascular event rather than typical respiratory symptoms. These patients were all subsequently found to have laboratory confirmed COVID-19 infections as the likely etiology of their thrombotic event. The primary presentation of COVID-19 infection as a thrombotic event rather than respiratory symptoms has not been described elsewhere. Our cases and discussion highlight the thrombotic complications caused by COVID-19, management of these patients, and explores the role of anticoagulation in patients diagnosed with COVID-19.