The effect of race on composite thrombotic events in patients with COVID-19

Esenwa, Charles; Unda, Santiago R.; Altschul, David; Patel, Nikunj; Malaviya, Avinash; Seiden, Johanna; Lendaris, Andrea; Moncrieffe, Khadean; Labovitz, Daniel L.

doi:10.1016/j.thromres.2020.12.015

Cited by 16 publications

(14 citation statements)

References 10 publications

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“…Furthermore, COVID-19 is a global health issue that impacts every race and ethnicity. A retrospective analysis of COVID-19 positive patients admitted to New York City hospitals failed to find significant interracial differences in the prevalence of stroke and other thrombotic events [63]. However, other studies have suggested instead that African Americans are at significantly higher risk of developing COVID-19 associated stroke even when controlling for co-morbidities such as hypertension as well as smoking status [64].…”

Section: Ischemic Strokementioning

confidence: 99%

Neurological Sequelae of COVID-19

Ahmad¹,

Feigen²,

Vazquez³

et al. 2022

J. Integr. Neurosci.

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Background: Though primarily a pulmonary disease, Coronavirus disease 2019 caused by the SARS-CoV-2 virus can generate devastating disease states that affect multiple organ systems including the central nervous system (CNS). The various neurological disorders associated with COVID-19 range in severity from mild symptoms such as headache, or myalgias to more severe symptoms such as stroke, psychosis, and anosmia. While some of the COVID-19 associated neurological complications are mild and reversible, a significant number of patients suffer from stroke. Studies have shown that COVID-19 infection triggers a wave of inflammatory cytokines that induce endothelial cell dysfunction and generate coagulopathy that increases the risk of stroke or thromboses. Inflammation of the endothelium following infection may also destabilize atherosclerotic plaque and induce thrombotic stroke. Although uncommon, there have also been reports of hemorrhagic stroke associated with COVID-19. The proposed mechanisms include a blood pressure increase caused by infection leading to a reduction in angiotensin converting enzyme-2 (ACE-2) levels that results in an imbalance of the renin-angiotensin system ultimately manifesting inflammation and vasoconstriction. Coagulopathy, as demonstrated by elevated prothrombin time (PT), has also been posited as a factor contributing to hemorrhagics stroke in patients with COVID-19. Other neurological conditions associated with COVID-19 include encephalopathy, anosmia, encephalitis, psychosis, brain fog, headache, depression, and anxiety. Though there are several hypotheses reported in the literature, a unifying pathophysiological mechanism of many of these disorders remains unclear. Pulmonary dysfunction leading to poor oxygenation of the brain may explain encephalopathy and other disorders in COVID-19 patients. Alternatively, a direct invasion of the CNS by the virus or breach of the blood-brain barrier by the systemic cytokines released during infection may be responsible for these conditions. Notwithstanding, the relationship between the inflammatory cytokine levels and conditions such as depression and anxiety is contradictory and perhaps the social isolation during the pandemic may in part be a contributing factor to some of the reported CNS disorders. Objective: In this article, we review the current literature pertaining to some of the most significant and common neurological disorders such as ischemic and hemorrhagic stroke, encephalopathy, encephalitis, brain fog, Long COVID, headache, Guillain-Barre syndrome, depression, anxiety, and sleep disorders in the setting of COVID-19. We summarize some of the most relevant literature to provide a better understanding of the mechanistic details regarding these disorders in order to help physicians monitor and treat patients for significant COVID-19 associated neurologic impairments. Methods: A literature review was carried out by the authors using PubMed with the search terms "COVID-19" and "Neurology", "Neurological Manifestations", "Neuropsychiatric ...

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Section: Ischemic Strokementioning

confidence: 99%

Neurological Sequelae of COVID-19

Ahmad¹,

Feigen²,

Vazquez³

et al. 2022

J. Integr. Neurosci.

Self Cite

View full text Add to dashboard Cite

show abstract

“…Table I details the study characteristics. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 These 11 studies included a total of 20,023 patients with a proportion of 27-54.2% of female patients. DVT and PE was a single outcome termed VTE in 5 studies and of those, a single study reported VTE and mortality as a composite primary outcome.…”

Section: Resultsmentioning

confidence: 99%

A systematic review and meta-analysis of racial disparities in deep vein thrombosis and pulmonary embolism events in patients hospitalized with coronavirus disease 2019

Bhakta

Erben

Sanghavi

et al. 2022

Journal of Vascular Surgery: Venous and Lymphatic Disorders

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“…These finding could be due to a possible difference in population genetics, food, and culture which might affect the coagulation system and does the coagulopathy due to B.1.617 (Delta variant) differ from the CAC with an absence of fibrinolysis activity we have so far seen in other parts of the world. 31 , 32 , 33 …”

Section: Discussionmentioning

confidence: 99%

Utility of Thromboelastography and velocity curve derivative in diagnosing COVID‐19 associated coagulopathy

Mohan

Wilson

Paonam

et al. 2022

Int J Lab Hematology

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Background COVID‐19 associated coagulopathy (CAC) can either be localized or systemic hypercoagulable state with increased risk of thromboembolism. This study looked into the usefulness of Thromboelastography (TEG) and the velocity curve (V‐curve) derivative from TEG in diagnosing and differentiating different stages of CAC. Materials and Methods A prospective single cohort study of RT‐PCR confirmed COVID‐19 patients was carried out for 2 weeks. Severe COVID‐19 patients in the adult critical care units with a TEG report were recruited for the study. Citrated kaolin TEG was performed on the day of admission before anticoagulation. TEG parameters included were R and K time, alpha angle, maximum amplitude, clotting index, lysis at 30 min. The first‐degree velocity curve of TEG is plotted as V‐curve which extrapolates thrombus generation potential. Parameters analyzed were the maximum rate of thrombus generation as well as thrombus generated (TG). Results The study included 43 patients with an average age of 58.34 (±15.35). TEG as well as V‐curve of all the patients were hypercoagulable compared with age‐matched reference range. We had 79.06% of patients in hypercoagulable stage. The mortality rate was 32.56% and 30.23% developed thrombotic incidents. Patients who succumbed to death had prolonged PT, aPTT, MA, Ly30, with a reduced TG (p < .05). The presence of fibrinolysis was associated with thromboembolism (OR = 6.76, CI = 1.48–25.82). Repeat TEG was done randomly in 11 patients and revealed a persistent hypercoagulable stage with increasing fibrinolysis activity. Conclusion TEG is a useful tool in diagnosing and categorizing Coagulopathy associated with COVID‐19.

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The effect of race on composite thrombotic events in patients with COVID-19

Cited by 16 publications

References 10 publications

Neurological Sequelae of COVID-19

Neurological Sequelae of COVID-19

A systematic review and meta-analysis of racial disparities in deep vein thrombosis and pulmonary embolism events in patients hospitalized with coronavirus disease 2019

Utility of Thromboelastography and velocity curve derivative in diagnosing COVID‐19 associated coagulopathy

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