Acute to post-acute COVID-19 thromboinflammation persistence: Mechanisms and potential consequences

Martins-Gonçalves, Remy; Hottz, Eugênio D.; Bozza, Patrı́cia T.

doi:10.1016/j.crimmu.2023.100058

Cited by 9 publications

(3 citation statements)

References 30 publications

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“…12,13 Lastly, persistent thromboinflammation with endotheliopathy, abnormal fibrin generation, and platelet hyperreactivity of arterial and venous vascular beds contribute to post-acute COVID-19 syndrome or long COVID-19. 14 Based on the high-quality data provided by randomized controlled trials, guidelines on appropriate inpatient and immediate post-discharge thromboprophylaxis for COVID-19 were recently published. 15 However, the risk of major thromboembolism and death remains elevated in the post-discharge period.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Risk Factors for Postdischarge Major Thromboembolism and Mortality in Hospitalized Patients with COVID-19 with Cardiovascular Comorbidities: Insights from the CORE-19 Registry

et al. 2023

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Background Coronavirus disease 2019 (COVID-19) is associated with venous and arterial thromboembolism (VTE and ATE) and all-cause mortality (ACM) in hospitalized patients. High-quality data are needed on post-discharge outcomes in patients with cardiovascular disease. Objectives To analyze outcomes and identify risk factors for ATE, VTE, and ACM in a high-risk subgroup of hospitalized COVID-19 patients with baseline cardiovascular disease. Methods We investigated post-discharge rates and associated risk factors of ATE, VTE, and ACM in 608 hospitalized COVID-19 patients with coronary artery disease (CAD), carotid artery stenosis (CAS), peripheral arterial disease (PAD), or ischemic stroke. Results Through 90 days post-discharge, outcome rates were: ATE 27.3% (10.2% myocardial infarction, 10.1% ischemic stroke, 13.2% systemic embolism, 12.7% major adverse limb event); VTE 6.9% (4.1% deep vein thrombosis, 3.6% pulmonary embolism); composite of ATE, VTE, or ACM 35.2% (214/608). Multivariate analysis showed significant association between this composite endpoint and age > 75 years (odds ratio [OR]: 1.90, 95% confidence interval [CI]: 1.22-2.94, p = 0.004), PAD (OR: 3.23, 95% CI: 1.80-5.81, p = < 0.0001), CAS (OR: 1.74, 95% CI: 1.11-2.75, p = 0.017), congestive heart failure (CHF) (OR: 1.84, 95% CI: 1.02-3.35, p = 0.044), previous VTE (OR: 3.08, 95% CI: 1.75-5.42, p < 0.0001), and intensive care unit (ICU) admission (OR: 2.93, 95% CI: 1.81-4.75, p < 0.0001). Conclusions COVID-19 inpatients with cardiovascular disease experience high rates of ATE, VTE, or ACM through 90 days post-discharge. Age > 75 years, PAD, CAS, CHF, previous VTE, and ICU admission are independent risk factors.

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Section: Accepted Manuscriptmentioning

confidence: 99%

“…12 13 Lastly, persistent thromboinflammation with endotheliopathy, abnormal fibrin generation, and platelet hyperreactivity of arterial and venous vascular beds contribute to postacute COVID-19 syndrome or long COVID-19. 14…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Postdischarge Major Thromboembolism and Mortality in Hospitalized Patients with COVID-19 with Cardiovascular Comorbidities: Insights from the CORE-19 Registry

et al. 2023

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“…Various hypotheses that have been formulated regarding the pathogenesis of long COVID include viral factors (i.e., persistence or reactivation), host factors (systemic inflammation and metabolic disorders), and downstream functional consequences (due to target tissue damage and dysfunction), and also include a number of disorders and abnormalities of hemostasis, such as persistent inflammation and endothelial dysfunction, hyperactivity of platelets and coagulation, impaired fibrinolysis, along with persistent fibrin microthrombosis. 3 4 These findings have led some authors to coin the term “vascular long-COVID.” 5…”

mentioning

confidence: 99%

Epidemiology and Predisposing Factors of Post-COVID Venous Thrombosis: A Concise Review

Lippi

Favaloro

2023

Semin Thromb Hemost

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Long-coronavirus disease 2019 (COVID-19) represents a heterogeneous clinical syndrome characterized by a pathologic continuum of signs, symptoms, and also laboratory/radiologic abnormalities that may persist for a long time after recovering from an acute severe acute respiratory syndrome-coronavirus disease 2 infection. Among the various components of this postviral condition, the risk of venous thromboembolism in patients hospitalized for COVID-19 remains considerably higher after discharge, especially in older individuals, in men, in patients with longer hospital stays and more aggressive treatment (e.g., mechanical ventilation and/or intensive care), when thromboprophylaxis is not used, and in those with a persistent prothrombotic state. Patients who have these predisposing factors should be monitored more closely to intercept any thrombosis that may occur in a post-COVID time-related manner but may also benefit from extended thromboprophylaxis and/or antiplatelet therapy.

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Secondary polycythemia in acutely ill COVID-19 patients is associated with higher mortality but not markedly higher thrombotic risk

Lucijanic,

Krecak,

Soric

et al. 2024

Scandinavian Journal of Clinical and Laboratory Investigation

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Acute to post-acute COVID-19 thromboinflammation persistence: Mechanisms and potential consequences

Cited by 9 publications

References 30 publications

Risk Factors for Postdischarge Major Thromboembolism and Mortality in Hospitalized Patients with COVID-19 with Cardiovascular Comorbidities: Insights from the CORE-19 Registry

Risk Factors for Postdischarge Major Thromboembolism and Mortality in Hospitalized Patients with COVID-19 with Cardiovascular Comorbidities: Insights from the CORE-19 Registry

Epidemiology and Predisposing Factors of Post-COVID Venous Thrombosis: A Concise Review

Secondary polycythemia in acutely ill COVID-19 patients is associated with higher mortality but not markedly higher thrombotic risk

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