Risk factors of venous thrombo-embolism during cytomegalovirus infection in immunocompetent individuals. A systematic review

Abstract

Most of the effects and complications of cytomegalovirus (CMV) infection are still unknown, even though its tropism for the endothelium has been extensively investigated. In fact, CMV is suspected to be a cause of venous thrombo-embolism (VTE) since 1974, but there is still no consensus about the management of CMV-related thrombosis and how to prevent it. Cytomegalovirus-related thrombosis has been reported mostly in immunocompromised patients, rarely in immunocompetent individuals. In order to identify potential risk factors of CMV-related thrombosis, we performed a systematic review of the literature regarding immunocompetent patients with cytomegalovirus infection and thrombosis. We found 115 cases with a mean age of 37.36 years (SD ± 16.43 years). Almost half the female patients were assuming EP contraception at the time of the event, and almost half the patients were affected by a coagulation disorder. Interestingly, just two women and four men had no risk factor for thrombosis other than the CMV infection at the time of the event. In conclusion, coagulation disorders and EP contraception have to be taken into a great deal of consideration in patients with CMV infection, since they could be important risk factors for VTE. Knowing the correlation with coagulation disorders, the use of anticoagulation drugs cannot be considered overtreatment. It was not feasible to determine the usefulness of an antiviral treatment. Further studies, even randomized ones, are required to determine the usefulness of antiviral drugs and the real prevalence of CMV-related VTE.

Cytomegalovirus-Induced Pericarditis, Pulmonary Embolism, and Transaminitis in an Immunocompetent Patient

“…Since the 1980s, thrombosis associated with CMV infections has been reported. The association between vascular thrombotic events and CMV infections has been demonstrated in a systematic review including 79 articles of 115 cases [7]. The incidences of thrombosis are rare and in hospitalized patients, and the incidence was seen to be 6.4% [13].…”

“…Recent literature reviews, however, report that at least 5% of hospitalized patients with CMV infection develop deep venous thrombosis (DVT) [6]. The correlation between thrombotic events and CMV infections has been demonstrated in a systematic review including 79 articles with 115 cases [7]. The most common DVTs are those of the lower extremities, followed by splanchnic vein thrombosis [8].…”

Cytomegalovirus infection with pulmonary embolism, splenic vein thrombosis and monoclonal gammopathy of undetermined significance: a case and systematic review

“…The VTE in our case could be attributed to either the acute CMV infection or the MGUS, as both relations have been reported. The relationship between acute CMV infection and VTE (table 2) has recently been demonstrated in a systematic review including 79 articles containing 115 cases of immunocompetent patients in total 22. As we identified the same references based on our search strategy, we decided to affirm their conclusion that CMV should be taken into consideration in all cases of thrombosis with no apparent cause.…”

Reactivation of Cytomegalovirus Increases Nitric Oxide and IL-10 Levels in Sepsis and is Associated with Changes in Renal Parameters and Worse Clinical Outcome

“…Hemodynamic disturbances in sepsis may range from a simple subclinical change in blood coagulation to a severe disseminated intravascular coagulation (ICD), characterized by the formation of microthrombi in vessels that contribute significantly to the dysfunction of various organs and consequent consumption of platelets and coagulation factors that may contribute to hemorrhagic manifestations 20,21 . This context suggests that CMV may be able to contribute to the thrombogenic events of sepsis through the direct interaction of platelets and extrinsic pathway activation of blood coagulation due to endothelial damage.…”