Mechanisms of COVID-19 Associated Pulmonary Thrombosis: A Narrative Review

Niculae, Cristian-Mihail; Hristea, Adriana; Moroti, Ruxandra

doi:10.3390/biomedicines11030929

Cited by 3 publications

(2 citation statements)

References 183 publications

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“…Thrombotic events in COVID-19 are multifactorial, being the results of a complex interplay between inflammation, endotheliopathy, coagulation pathways, platelet dysfunction and fibrinolysis disbalance, and this could explain the failure of anticoagulation [ 1 , 50 , 51 , 52 , 53 ] ( Figure 2 ).…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Pulmonary Thrombosis despite Therapeutic Anticoagulation in COVID-19 Pneumonia: A Case Report and Literature Review

Niculae,

Gorea,

Tirlescu

et al. 2023

Viruses

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The rate of thrombotic complications in COVID-19 patients is high and could be associated with the risk of unfavourable outcomes. Moreover, pulmonary thrombotic events can occur even in patients already on anticoagulant treatment. We present the case of a patient with severe COVID-19 pneumonia, without traditional risk factors for thrombosis, who developed massive pulmonary thrombosis (PT) despite therapeutic anticoagulation. The diagnosis was challenging, and the case raised concerns about the protective role of conventional anticoagulant treatment in COVID-19 pneumonia. Thus, we searched for literature reports on COVID-19 patients who developed PT despite being under anticoagulation therapy. We identified 13 cohort studies including 4058 patients of which 346 (8.5%) developed PT and nine case reports/series enrolling 14 patients. Four cohorts were further analysed, which reported data on risk factors for thrombosis, outcomes and biological characteristics. We found that there were no differences between patients with and without PT regarding the classical risk factors for thrombosis. PT occurred regardless of the anticoagulation regimen, and the risk factor identified was severe COVID-19 pneumonia and a stay in an intensive care unit (ICU). Pulmonary thrombotic events in patients with COVID-19 are rather inflammation-related than correlated with traditional thromboembolic risk factors, and the therapeutic approach must take into consideration this aspect.

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Section: Discussion and Literature Reviewmentioning

confidence: 99%

Pulmonary Thrombosis despite Therapeutic Anticoagulation in COVID-19 Pneumonia: A Case Report and Literature Review

Niculae,

Gorea,

Tirlescu

et al. 2023

Viruses

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“…COVID-19-associated pulmonary thrombosis is an in situ immunothrombosis not related to venous thromboembolism, in which similar mechanisms involving endothelial injury and a loss of anticoagulant properties can be incriminated [ 19 ].…”

mentioning

confidence: 99%

Special Issue “COVID-19 Coagulopathy: Advances on Pathophysiology and Therapies”

Russu,

Arbănaşi,

Șchiopu

2024

IJMS

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Morphofunctional characteristics of the vessels of the small circle of blood circulation in those who died from severe and extremely severe forms of new coronavirus infection

Emelin,

Sorochanu,

Asaulenko

et al. 2024

Morphology

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BACKGROUND: An important feature of COVID-19 is the development of pronounced hypercoagulation with an increased risk of thrombotic damage to the pulmonary vascular bed, mainly the pulmonary arteries. Thrombosis of the pulmonary blood vessels causes a local violation of hemodynamics with the development of hyperemia, edema, which leads to a decrease in ventilation of the lung tissue area and serves as one of the causes of respiratory failure. AIM: This study aimed to conduct a morphological and morphometric analysis of the vascular bed of lung tissues in deceased with severe and extremely severe forms of new coronavirus infection who were on inpatient treatment in the period 2020-2022. METHODS: A pathomorphologic study of 129 autopsy cases with a confirmed diagnosis of a new coronavirus infection COVID-19 was performed. Morphometric analysis and statistical data processing of the pulmonary vascular system in histologic preparations stained with hematoxylin and eosin stain, orcein stain and Martius Scarlet Blue (MSB) stain was performed. The control group consisted of 14 patients who died of cardiovascular disease with bilateral focal confluent pneumonia. RESULTS: It was found that the proportion of thrombosed vessels in the lung tissues of the deceased was 27.6%. In 87.2% of cases, thrombosis develops in small arteries (lumen diameter 30-500 microns) and small veins (lumen diameter 40-500 microns). The vascular-functional indices of Kernogan and Vogenworth were statistically significantly increased in small arteries and small veins of the 4th order (p=0.001), small arteries (p=0.001) and small veins of the 5th order (p=0.014) compared with the control group. CONCLUSION: Diffuse involvement of small caliber blood vessels in the pathological process reflects the severity of specific hemocoagulopathic disorders in the lung tissue. Such disorders lead to the development of ventilation-perfusion disorders and entail an increase in right ventricular failure.

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Mechanisms of COVID-19 Associated Pulmonary Thrombosis: A Narrative Review

Cited by 3 publications

References 183 publications

Pulmonary Thrombosis despite Therapeutic Anticoagulation in COVID-19 Pneumonia: A Case Report and Literature Review

Pulmonary Thrombosis despite Therapeutic Anticoagulation in COVID-19 Pneumonia: A Case Report and Literature Review

Special Issue “COVID-19 Coagulopathy: Advances on Pathophysiology and Therapies”

Morphofunctional characteristics of the vessels of the small circle of blood circulation in those who died from severe and extremely severe forms of new coronavirus infection

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