Inflammation and thrombosis in patients with COVID-19: a prothrombotic and inflammatory disease caused by SARS Coronavirus-2

Abstract

Coronavirus disease 2019 (COVID-19) caused by “Severe Acute Respiratory Syndrome Coronavirus-2” (SARS-CoV-2) infection emerged in Wuhan, a city of China, and spread to the entire planet in early 2020. The virus enters the respiratory tract cells and other tissues via ACE2 receptors. Approximately 20% of infected subjects develop severe or critical disease. A cytokine storm leads to over inflammation and thrombotic events. The most common clinical presentation in COVID-19 is pneumonia, typically characterized by bilateral, peripheral, and patchy infiltrations in the lungs. However multi-systemic involvement including peripheral thromboembolic skin lesions, central nervous, gastrointestinal, circulatory, and urinary systems are reported. The disease has a higher mortality compared to other viral agents causing pneumonia and unfortunately, no approved specific therapy, nor vaccine has yet been discovered. Several clinical trials are ongoing with hydroxychloroquine, remdesivir, favipiravir, and low molecular weight heparins. This comprehensive review aimed to summarize coagulation abnormalities reported in COVID-19, discuss the thrombosis, and inflammation-driven background of the disease, emphasize the impact of thrombotic and inflammatory processes on the progression and prognosis of COVID-19, and to provide evidence-based therapeutic guidance, especially from antithrombotic and anti-inflammatory perspectives.

Cutaneous findings following COVID‐19 vaccination: review of world literature and own experience

“…chilblain‐like lesions, morbilliform rashes and vasculitis) SARS‐CoV‐2 vaccines appear to have also the potential to induce a broad spectrum of cutaneous adverse events. 1 , 2 , 3 , 4 , 5 In this review article, 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , …”

α-Ketoglutarate Inhibits Thrombosis and Inflammation by Prolyl Hydroxylase-2 Mediated Inactivation of Phospho-Akt

“…Supplementation with dietary aKG, a metabolite of TCA cycle and a cofactor of PHD2, appears to be a potent suppressor of pAkt, significantly reducing thrombotic and inflammatory events in mice treated with thrombosis-inducing agent carrageenan [26]. Reports suggest that SARS-CoV-2 directly activates platelets [27,28] and symptoms like thrombosis and inflammation are common in severe forms of COVID-19 [29]. We have tested the rescue effect of dietary aKG on lung inflammation in SARS-CoV-2 infected golden hamsters.…”

Pulmonary embolism after COVID-19 vaccination

“…It has been well-established that infection with coronavirus triggers inflammatory pathways and leads to a hypercoagulable state [1]. When the virus invades normal human cells it begins by causing local inflammation via cytokine activation, damage to tissues, and recruitment of inflammatory cells.…”