COVID-19 Coagulopathy: From Pathogenesis to Treatment

Alnima, Teba; Mulder, Marlies; Bussel, Bas C.T. van; Cate, Hugo Ten

doi:10.1159/000522498

Cited by 26 publications

(31 citation statements)

References 135 publications

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“…Although much has been learned in the past 2 years about the pathophysiology of COVID-19, insights into the triggering events of CAC remain elusive, as do effective preventative and therapeutic strategies (see Table 1 ). This is evident from the uncertainties and controversy surrounding the use of several therapeutic agents in different clinical scenarios 150 , 151 . This is not surprising, given that CAC is a highly complex and dynamic process, involving the interplay between multiple biochemical, proteolytic and cellular pathways.…”

Section: Discussionmentioning

confidence: 99%

Understanding COVID-19-associated coagulopathy

et al. 2022

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COVID-19-associated coagulopathy (CAC) is a life-threatening complication of SARS-CoV-2 infection. However, the underlying cellular and molecular mechanisms driving this condition are unclear. Evidence supports the concept that CAC involves complex interactions between the innate immune response, the coagulation and fibrinolytic pathways, and the vascular endothelium, resulting in a procoagulant condition. Understanding of the pathogenesis of this condition at the genomic, molecular and cellular levels is needed in order to mitigate thrombosis formation in at-risk patients. In this Perspective, we categorize our current understanding of CAC into three main pathological mechanisms: first, vascular endothelial cell dysfunction; second, a hyper-inflammatory immune response; and last, hypercoagulability. Furthermore, we pose key questions and identify research gaps that need to be addressed to better understand CAC, facilitate improved diagnostics and aid in therapeutic development. Finally, we consider the suitability of different animal models to study CAC.

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Section: Discussionmentioning

confidence: 99%

Understanding COVID-19-associated coagulopathy

et al. 2022

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“…It is important to note that hemodynamic responses during V-V ECMO support are complex and vary among patients due to multiple clinical variables. Microthrombi, pulmonary arterial remodeling, vasoconstriction from hypoxia, acidosis, and/or in ammatory mediators, deleterious effects of mechanical ventilation on RV function, sepsisinduced tissue demands could be paired to hemodynamic dysfunction 52,53 . Moreover, RV failure could be worsened by the loading due to the ECMO itself 54 .…”

Section: Multi-step Practical Approachmentioning

confidence: 99%

Hemodynamic Monitoring during Veno-Venous Extracorporeal Membrane Oxygenation: A scoping review

Lorusso

Piero

Mariani

et al. 2022

Preprint

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Background Optimizing cardiovascular monitoring and support during veno-venous Extracorporeal Membrane Oxygenation (V-V ECMO) is essential to ensure overall adequacy of end-organ perfusion and proper titration of extracorporeal support. Despite an increasing V-V ECMO use, guidelines on monitoring of cardiovascular function during mechanical support are lacking, with current approaches mostly based on clinicians’ experience rather than evidence-based recommendations. This scoping review focused on basic and more advance methods for hemodynamic monitoring during V-V ECMO in adult patients. Methods Databases (PubMed, EMBASE and Cochrane CENTRAL) and reference lists of relevant articles were searched from inception until November 2021. We included studies of any methodology that addressed the a priori key questions relating to hemodynamic monitoring during respiratory extracorporeal support. Results Overall, 465 articles were screened, and 106 articles were included for detailed analysis. Protocolized hemodynamic monitoring and lines of evidence were not found and in particular the main body of the literature was concentrated on cardiocirculatory support. Tools recommendations regarding the available monitoring techniques are described, with an overview of basic, prognostic/diagnostic and advanced methods. While these strategy does not influence time to wean, the application of care bundles and multidisciplinary team approaches could be associated with reduced complications and improved outcomes. Conclusions Patients undergoing respiratory support with V-V ECMO experience complex interactions among the patient’s and extracorporeal circulation, individual’s lung function and related circulatory changes. The critical needs for multidisciplinary teams, specified trainings, new research directions, and an accurate monitoring aiming to improve outcomes are essential for optimal decision-making.

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“…Alnima et al [1] review the various aspects of CO-VID-19 coagulopathy, including pathophysiology, clinical and laboratory characteristics, as well as differences from disseminated intravascular coagulation. They also provide an overview of the pathophysiology of vaccine induced thrombosis and thrombocytopenia and provide available data on risk factors for this highly fatal adverse event.…”

mentioning

confidence: 99%

“…Currently, there are no explicit contraindications for adenovirus-based vaccines due to risk of vaccine induced thrombosis and thrombocytopenia. In addition, the authors provide a summary of current evidence of anticoagulant strategies for the management of patients with COVID-19 infection [1].…”

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confidence: 99%