COVID-19-associated coagulopathy

Franchini, Massimo; Marano, Giuseppe; Cruciani, Mario; Mengoli, Carlo; Pati, Ilaria; Masiello, Francesca; Veropalumbo, Eva; Pupella, Simonetta; Vaglio, Stefania; Liumbruno, Giancarlo Maria

doi:10.1515/dx-2020-0078

Cited by 53 publications

(54 citation statements)

References 57 publications

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“…There are many publications showing thromboembolic complications of the virus. Although some patients receive anticoagulant therapy, thromboembolic complications may occur [27]. Thrombotic microangiopathy and widespread microthrombosis were observed in postmortem histopathological studies.…”

Section: Discussionmentioning

confidence: 99%

The effect of moderate and severe COVID-19 pneumonia on short-term right ventricular functions: a prospective observational single pandemic center analysis

Günay

Demiröz

Kahyaoğlu

et al. 2021

Int J Cardiovasc Imaging

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It has been reported that myocardial damage and heart failure are more common in COVID-19 patients with severe symptoms. The aim of our study was to measure the right ventricular functions of COVID-19 patients 30 days after their discharge, and compare them to the right ventricular functions of healthy volunteers. Fifty one patients with COVID-19 and 32 healthy volunteers who underwent echocardiographic examinations were enrolled in our study. 29 patients were treated for severe and 22 patients were treated for moderate COVID-19 pneumonia. The study was conducted prospectively, in a single center, between 15 May 2020 and 15 July 2020. We analyzed the right ventricular functions of the patients using conventional techniques and two-dimensional speckle-tracking. Right ventricular end-diastolic and end-systolic area were statistically higher than control group. The right ventricular fractional area change (RVFAC) was significantly lesser in the patient group compared to the control group. Tricuspid annular plane systolic motion (TAPSE) was within normal limits in both groups, it was lower in the patient group compared to the control group. Pulmonary artery pressure was found to be significantly higher in the patient group. Right ventricular global longitudinal strain (RV-GLS) was lesser than the control group (− 15.7 [(− 12.6)–(− 18.7)] vs. − 18.1 [(− 14.8)–(− 21)]; p 0.011). Right ventricular free wall strain (RV-FWS) was lesser in the patient group compared to the control group (− 16 [(− 12.7)–(− 19)] vs − 21.6 [(− 17)–(− 25.3)]; p < 0.001). We found subclinical right ventricular dysfunction in the echocardiographies of COVID-19 patients although there were no risk factors.

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Section: Discussionmentioning

confidence: 99%

The effect of moderate and severe COVID-19 pneumonia on short-term right ventricular functions: a prospective observational single pandemic center analysis

Günay

Demiröz

Kahyaoğlu

et al. 2021

Int J Cardiovasc Imaging

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“…3,4,18,69,74 COVID-19-associated coagulopathy occurs proportional to disease severity and leads to treatment-resistant thrombotic and haemorrhagic events; characterised by d-dimer elevation with prothrombin prolongation and thrombocytopenia. [74][75][76][77] Furthermore, cytokine-and hypoxia-induced injury to the corpus callosum, particularly the splenium, has been reported within critical illness including acute respiratory distress syndrome and high-altitude cerebral oedema, potentially contributing to a vulnerability in COVID-19. 17,[78][79][80][81][82][83] Hypoxia directly induces chemical and hydrostatic endothelial cell disruption, promoting vascular permeability and hence contributing to neurological event pathogenesis.…”

Section: Neurological Events In White and Grey Mattermentioning

confidence: 99%

Modelling the Anatomical Distribution of Neurological Events in COVID-19 Patients: A Systematic Review

Parsons

Outsikas

Parish

et al. 2020

Preprint

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Background Neuropathology caused by the coronavirus disease 2019 (COVID-19) has been reported across several studies. The characterisation of the spatial distribution of these pathology remains critical to assess long and short-term neurological sequelae of COVID-19. To this end, Mathematical models can be used to characterise the location and aetiologies underlying COVID-19-related neuropathology. Method We performed a systematic review of the literature to quantify the locations of small neurological events identified with magnetic resonance imaging (MRI) among COVID-19 patients. Neurological events were localised into the Desikan-Killiany grey and white matter atlases. A mathematical network diffusion model was then used to test whether the spatial distribution of neurological events could be explained via a linear spread through the structural connectome of the brain. Findings We identified 35 articles consisting of 123 patients that assessed the spatial distribution of small neurological events among COVID-19 patients. Of these, 91 patients had grey matter changes, 95 patients had white matter changes and 72 patients had confirmed cerebral microbleeds. White matter events were observed within 14 of 42 white matter bundles from the IIT atlas. The highest proportions (26%) of events were observed within the bilateral corticospinal tracts. The splenium and middle of the corpus callosum were affected in 14% and 9% of the cases respectively. Grey matter events were spatially distributed in the 41 brain regions within the Desikan-Killiany atlas. The highest proportions (~10%) of the events were observed in areas including the bilateral superior temporal, precentral, and lateral occipital cortices. Sub-cortical events were most frequently identified in the Pallidum. The application of a mathematical network diffusion model suggested that the spatial pattern of the small neurological events in COVID-19 can be modelled with a linear diffusion of spread from epicentres in the bilateral cerebellum and basal ganglia (Pearsons r=0.41, p<0.001, corrected). Interpretation To our knowledge, this is the first study to systematically characterise the spatial distribution of small neurological events in COVID-19 patients and test whether the spatial distribution of these events can be explained by a linear diffusion spread model. The location of neurological events is consistent with commonly identified neurological symptoms including alterations in conscious state among COVID-19 patients that require brain imaging. Given the prevalence and severity of these manifestations, clinicians should carefully monitor neurological symptoms within COVID-19 patients and their potential long-term sequelae.

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“…8 The molecular mechanisms responsible for the hypercoagulable state observed in patients with COVID-19 are still incompletely elucidated; however, there appears to be a close link between inflammatory and hemostatic systems ( Figure 1). 9,10 Current data suggest that COVID-19 can infect endothelial cells with an ensuing associated immune response and attendant activation of inflammatory pathways resulting in dysregulation of the endothelium, leukocyte activation, neutrophil extracellular traps (NET) generation (a matrix of DNA decorated with neutrophil granule proteins, such as myeloperoxidase, cathepsin G, and neutrophil elastase), complement deposition, and platelet activation and consumption. 10 It has been suggested that the virus instigates the process of pyroptosis, an inflammatory form of programmed cell death observed upon infection with intracellular pathogens, which could contribute to the endothelial cell death after COVID-19 infection and could increase proinflammatory cytokine releases, such as interleukin (IL)-1 beta and IL-18.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Infection: Viral Macro- and Micro-Vascular Coagulopathy and Thromboembolism/Prophylactic and Therapeutic Management

Manolis¹,

Manolis

et al. 2020

J Cardiovasc Pharmacol Ther

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Coronavirus-2019 (COVID-19) predisposes patients to arterial and venous thrombosis commonly complicating the clinical course of hospitalized patients and attributed to the inflammatory state, endothelial dysfunction, platelet activation and blood stasis. This viral coagulopathy may occur despite thromboprophylaxis and raises mortality; the risk appears highest among critically ill inpatients monitored in the intensive care unit. The prevalence of venous thromboembolism in COVID-19 patients has been reported to reach ∼10-35%, while autopsies raise it to nearly 60%. The most common thrombotic complication is pulmonary embolism, which though may occur in the absence of a recognizable deep venous thrombosis and may be due to pulmonary arterial thrombosis rather than embolism, resulting in thrombotic occlusion of small- to mid-sized pulmonary arteries and subsequent infarction of lung parenchyma. This micro-thrombotic pattern seems more specific for COVID-19 and is associated with an intense immuno-inflammatory reaction that results in diffuse occlusive thrombotic micro-angiopathy with alveolar damage and vascular angiogenesis. Furthermore, thrombosis has also been observed in various arterial sites, including coronary, cerebral and peripheral arteries. Biomarkers related to coagulation, platelet activation and inflammation have been suggested as useful diagnostic and prognostic tools for COVID-19-associated coagulopathy; among them, D-dimer remains a key biomarker employed in clinical practice. Various medical societies have issued guidelines or consensus statements regarding thromboprophylaxis and treatment of these thrombotic complications specifically adapted to COVID-19 patients. All these issues are detailed in this review, data from meta-analyses and current guidelines are tabulated, while the relevant mechanisms of this virus-associated coagulopathy are pictorially illustrated.

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COVID-19-associated coagulopathy

Cited by 53 publications

References 57 publications

The effect of moderate and severe COVID-19 pneumonia on short-term right ventricular functions: a prospective observational single pandemic center analysis

The effect of moderate and severe COVID-19 pneumonia on short-term right ventricular functions: a prospective observational single pandemic center analysis

Modelling the Anatomical Distribution of Neurological Events in COVID-19 Patients: A Systematic Review

COVID-19 Infection: Viral Macro- and Micro-Vascular Coagulopathy and Thromboembolism/Prophylactic and Therapeutic Management

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