Pulmonary intravascular coagulation in COVID-19: possible pathogenesis and recommendations on anticoagulant/thrombolytic therapy

Belen-Apak, Fatma Burcu; Sarıalıoğlu, Faık

doi:10.1007/s11239-020-02129-0

Cited by 76 publications

(71 citation statements)

References 9 publications

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“…The latter could be secondary to the acute respiratory distress syndrome seen in critically ill COVID-19 patients, which results in RV systolic dysfunction (8,32,33). Despite not being overly sensitive for a pulmonary embolism (PE), echocardiographic features of right heart strain and right heart dysfunction can indicate the presence of a pulmonary embolus (PE) or Pulmonary Intravascular Coagulation (PIC) which has been hypothesised to be one of the causative mechanisms leading to respiratory distress in COVID-19 patients (34).…”

Section: Discussionmentioning

confidence: 99%

Observations on echocardiographic findings in patients with COVID-19

Khan

James

Yuan

et al. 2020

Preprint

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Background The novel coronavirus (SARS-CoV-2) has created global havoc by causing Coronavirus Disease 2019 (COVID-19). Cardiovascular involvement in COVID-19 varies from troponin rise or arrhythmia/myocarditis to fulminant cardiogenic shock. There is limited data on echocardiographic findings in such patients. We aimed to assess abnormal echocardiographic findings and contributory factors in patients with COVID-19.Methods We performed retrospective analysis of COVID-19 positive patients who underwent a transthoracic echocardiogram (TTE) at Sandwell and West Birmingham (SWBH) NHS Trust between March 2020 and May 2020. Patients were compared based on TTE changes and divided into two groups (abnormal TTE and normal TTE).Results 66 out of 463 patients with COVID-19 had a TTE. 46 patients (69.7%) had abnormal findings on their TTE. Tricuspid regurgitation was the most common abnormality observed (26 (56.5%) patients), followed by aortic regurgitation (13 (28.3%) patients) and mitral regurgitation (12 (26.1%) patients). Haemoglobin and LDH were predictors of abnormal TTE (Hb OR: 0.97, p = 0.049, LDH, OR: 1.00, p = 0.03). Significantly more patients in the abnormal TTE group died during their inpatient stay compared to normal TTE (p = 0.01). Having an abnormal TTE was an independent predictor of death on regression analysis (OR: 0.229, p = 0.034).Conclusions This is the first detailed observational study looking at echocardiographic changes in admitted COVID-19 patients irrespective of disease severity. The most common abnormality was valve regurgitation. Patients with abnormal TTE were more likely to die in hospital.

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Section: Discussionmentioning

confidence: 99%

Observations on echocardiographic findings in patients with COVID-19

Khan

James

Yuan

et al. 2020

Preprint

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“…In severe COVID-19, the thrombotic tendency is systemic, with a strong immunoinflammatory response described as a “cytokine storm”. However, the opinion has been put forward that this phenomenon should instead be called “pulmonary intravascular coagulopathy”, as opposed to DIC, because the thrombosis occurs overwhelmingly in the lungs rather than the whole body [ 30 – 33 ]. This so-called pulmonary intravascular coagulopathy shows not only macrothrombosis in the lung, but also frequently the more troublesome microthrombosis in a wide area of lung.…”

Section: Pulmonary Intravascular Coagulopathymentioning

confidence: 99%

COVID-19-associated coagulopathy and disseminated intravascular coagulation

2020

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The pathology of coronavirus disease 2019 (COVID-19) is exacerbated by the progression of thrombosis, and disseminated intravascular coagulation (DIC), and cytokine storms. The most frequently reported coagulation/fibrinolytic abnormality in COVID-19 is the increase in d -dimer, and its relationship with prognosis has been discussed. However, limits exist to the utility of evaluation by d -dimer alone. In addition, since the coagulation/fibrinolytic condition sometimes fluctuates within a short period of time, regular examinations in recognition of the significance of the examination are desirable. The pathophysiology of disseminated intravascular coagulation (DIC) associated with COVID-19 is very different from that of septic DIC, and both thrombotic and hemorrhagic pathologies should be noted. COVID-19 thrombosis includes macro- and microthrombosis, with diagnosis of the latter depending on markers of coagulation and fibrinolysis. Treatment of COVID-19 is classified into antiviral treatment, cytokine storm treatment, and thrombosis treatment. Rather than providing uniform treatment, the treatment method most suitable for the severity and stage should be selected. Combination therapy with heparin and nafamostat is expected to develop in the future. Fibrinolytic therapy and adsorption therapy require further study

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“…In recently emerging reports, however, viral pneumonia is highly questioned; rather, thrombotic microangiopathy or atypical disseminated intravascular coagulation (DIC) with increased risk of pulmonary vascular coagulation and thromboembolism are emphasized as major pathological disorders associated with COVID-19 ( Belen-Apak and Sarıalioğlu, 2020 ; Cao and Li, 2020 ; Kollias et al, 2020 ).…”

Section: A Brief Update On the Pathophysiology Of Covid-19mentioning

confidence: 99%

What immunological and hormonal protective factors lower the risk of COVID-19 related deaths in pregnant women?

Berhan

2020

Journal of Reproductive Immunology

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Highlights Despite pregnant women are at higher risk for viral infection, including SARS CoV and MERS CoV, primarily due to Th-1 and Th-17 suppression, they are at less risk for COVID-19. Pregnancy does not look increasing the risk of COVID-19 related mortality. The bilateral immunological response to COVID-19 is partly attributed to the lower risk of mortality. The immune modulating and anti-inflammatory effect of IL-10, Estriol, Progesterone and Vitamin D (all increased during pregnancy) and the undetectable PAR-1 may have a protective effect. In pregnant women, COVID-19 and many of the autoimmune diseases have something in common. Potential treatment options are proposed.

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Pulmonary intravascular coagulation in COVID-19: possible pathogenesis and recommendations on anticoagulant/thrombolytic therapy

Cited by 76 publications

References 9 publications

Observations on echocardiographic findings in patients with COVID-19

Observations on echocardiographic findings in patients with COVID-19

COVID-19-associated coagulopathy and disseminated intravascular coagulation

What immunological and hormonal protective factors lower the risk of COVID-19 related deaths in pregnant women?

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