Coagulation Status and Venous Thromboembolism Risk in African Americans: A Potential Risk Factor in COVID-19

Abstract

Severe acute respiratory syndrome coronavirus 2 infection (COVID-19) is known to induce severe inflammation and activation of the coagulation system, resulting in a prothrombotic state. Although inflammatory conditions and organ-specific diseases have been shown to be strong determinants of morbidity and mortality in patients with COVID-19, it is unclear whether preexisting differences in coagulation impact the severity of COVID-19. African Americans have higher rates of COVID-19 infection and disease-related morbidity and mortality. Moreover, African Americans are known to be at a higher risk for thrombotic events due to both biological and socioeconomic factors. In this review, we explore whether differences in baseline coagulation status and medical management of coagulation play an important role in COVID-19 disease severity and contribute to racial disparity trends within COVID-19.

The East Asian Paradox: An Updated Position Statement on the Challenges to the Current Antithrombotic Strategy in Patients with Cardiovascular Disease

“…63,69 African Americans show a trend toward having higher baseline levels of coagulation factor VIII, von Willebrand factor, thrombin generation, and D-dimer. 63,70 Obesity is an important risk factor of CVD occurrence, which is most popular in the African American population. This phenotype presents a vicious cycle related with the progression of atherothrombosis, due to oxidative stress, chronic thromboinflammatory cascade, and platelet activation.…”

Venous Thromboembolism in COVID-19

“… 19 A study has reported that male, white, and African American COVID-19 patients may have more significant hypercoagulability. 20 In addition, hypoxia, sepsis, preeclampsia, and postpartum infection are also common risk factors for VTE in COVID-19 patients. 21 22 In other words, all etiologies that lead to hemoconcentration, slow blood rheology, and increased viscosity contribute to the formation of VTE ( Fig.…”

Ethnic Difference of Thrombogenicity in Patients with Cardiovascular Disease: a Pandora Box to Explain Prognostic Differences

“… 4) Meanwhile, African Americans exhibit a trend toward having higher levels of von Willebrand factor, factor VIII, thrombin generation, and D-dimer. 4) 52) Compared to subjects from other ethnic background, East Asians have the lowest levels of fibrinogen, factor VIII and D-dimer. 7) 28) …”

“… 98) Individuals of African descent living in the United States or European countries have worse outcomes with COVID-19 than Caucasians and Asians. 52) Their vulnerability is not fully explained by the differences in social and economic factors. 20) Activity of coagulation-inflammation cascade and predisposition to the development of coagulopathy varies between the races, with African Americans trending toward a more prothrombotic state ( Tables 1 and 2 ).…”