Thromboembolic events and Covid-19

Abstract

The novel Corona virus infection (Covid-19) first identified in China in December 2019 has rapidly progressed in pandemic leading to significant mortality and unprecedented challenge for healthcare systems. Although the clinical spectrum of Covid-19 is variable, acute respiratory failure and systemic coagulopathy are common in severe Covid-19 patients. Lung is an important target of the SARS-CoV-2 virus causing eventually acute respiratory distress syndrome associated to a thromboinflammatory state. The cytokinic storm, thromboinflammation and pulmonary tropism are the bedrock of tissue lesions responsible for acute respiratory failure and for prolonged infection that may lead to multiple organ failure and death. The thrombogenicity of this infectious disease is illustrated by the high frequency of thromboembolic events observed even in Covid-19 patients treated with anticoagulation. Increased D-Dimers, a biomarker reflecting activation of hemostasis and fibrinolysis, and low platelet count (thrombocytopenia) are associated with higher mortality in Covid-19 patients. In this review, we will summarize our current knowledge on the thromboembolic manifestations, the disturbed hemostatic parameters, and the thromboinflammatory conditions associated to Covid-19 and we will discuss the modalities of anticoagulant treatment or other potential antithrombotic options.

COVID-19 associated atrial fibrillation: Incidence, putative mechanisms and potential clinical implications

“…The first experiences in the Wuhan province in China and then in other parts of the world allowed to estimate the putative incidence of thromboembolic complications ranging from around 15% to 85% in hospitalized COVID-19 patients [80] . Of note, thromboembolic risk is influenced by race and ethnicity, and is significantly lower in Chinese compared to Caucasian individuals [81] .…”

A 21st Century Evil: Immunopathology and New Therapies of COVID-19

“…More recently, reports on COVID-19 have included the occurrence of coagulation abnormalities in most critically ill patients (128)(129)(130)(131). Tang et al (132) reported the occurrence of disseminated intravascular coagulation in 71.4% of nonsurviving COVID-19 patients and in only 0.6% of surviving patients, suggesting a high frequency in severe COVID-19 patients.…”

“…However, COVID-19 has some distinct features that may establish a new category of coagulopathy, denominated COVID-19 associated coagulopathy (CAC), whose main markers are higher D-dimer concentration and fibrinogen levels, a relatively lower platelet count, and longer prothrombin time (129). In COVID-19 patients, CAC has been associated with higher mortality (131).…”

RT-PCR Mediated Identification of SARS-CoV-2 Patients from Particular Regions of Bangladesh and the Multi-factorial Analysis Considering Their Pre and Post Infection Health Conditions

“…Among all the patients (n=205), there was no case of sudden death due to myocardial infarction, venous thromboembolism or pulmonary embolism. Though, research conducted by Carfora et al (2020) showed similar findings [40], thromboprophylaxis was recommended for preventing thromboembolic events by Ribes et al (2020) [41]. However, therapeutic and prophylactic doses of anticoagulants are still clouded and different hospitals are using different regimens amidst concurrent death of patients [42].…”