Thrombosis and COVID-19 pneumonia: the clot thickens!

Price, Laura; McCabe, Colm; Garfield, Benjamin; Wort, Stephen J.

doi:10.1183/13993003.01608-2020

Cited by 170 publications

(179 citation statements)

References 39 publications

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“…(20,44) It is hypothesized that in severe clinical COVID-19 pneumonia, the massive release of in ammatory mediators caused by viral replication might be contributed to endothelial injury and intravascular thrombosis. (45) Our ndings support the association between clinical severity and hypercoagulable state causing by COVID-19.…”

Section: Discussionsupporting

confidence: 78%

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Incidence of thromboembolism in patients with COVID-19: a systematic review and meta-analysis

Boonyawat

Chantrathammachart

Numthavej

et al. 2020

Preprint

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Background: Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, the incidence of thromboembolism has been increasingly reported. The aim of this systematic review was to explore the incidence of venous and arterial thromboembolism among COVID-19 patients requiring hospitalization.Methods: Medline, Embase, Scopus, and grey literature were searched until May 2020. Observational studies reported on the incidence of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT) or arterial thromboembolism (ATE) were included. The pool incidences and their 95% confidence intervals (CI) were calculated using the random-effects model.Results: A total of 36 studies were included. In the intensive care unit (ICU) setting, the pooled incidence of VTE was 28% (95% CI, 22-34%). Subgroups based on compression ultrasound (CUS) screening revealed a higher incidence of DVT in the CUS screening group than in the no CUS screening group (32% [95% CI, 18-45%] vs. 6% [95% CI, 4-9%]). The pooled incidence of ATE in ICU was 3% (95% CI, 2-5%). In the non-ICU setting, the pooled incidence of VTE was 10% (95% CI, 6-14%,).Conclusions:The incidence of VTE in COVID-19 patients was higher in the ICU setting than in the non-ICU setting, and also significantly higher in studies that incorporated the CUS screening protocol. The incidence of ATE in the ICU setting was low. VTE prophylactic measures should be given to all hospitalized patients diagnosed with COVID-19.

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Section: Discussionsupporting

confidence: 78%

“…This could re ect the microvascular thrombosis "in situ" caused by endothelial injury and local in ammation. (45,48) Data on VTE-related death were limited. Few studies reported the outcome of death in patients with VTE, but it could not be assumed to be VTE-related death in all patients.…”

Section: Discussionmentioning

confidence: 99%

Incidence of thromboembolism in patients with COVID-19: a systematic review and meta-analysis

Boonyawat

Chantrathammachart

Numthavej

et al. 2020

Preprint

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“…Our results propose COVID-19-increased D-dimer level as a clear consequence of respiratory disease through the development of capillary microthrombosis, as observed in post-mortem studies (3,11) and attributed to a vascular thickening or vascular congestion (24). Thus, in COVID-19, hypothesis of microthrombosis is proposed in lung but also in kidney since the elevation of serum creatinine was associated with higher levels of D-dimers (> 500 ng/mL) (25).…”

Section: Discussionsupporting

confidence: 63%

D-dimers at hospital admission for COVID-19 are associated with in hospital mortality independently of venous thromboembolism: Insight from a French multicenter cohort study

Chocron

Duceau²,

Gendron³

et al. 2020

Preprint

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Background: Coronavirus disease 2019 (COVID-19) has been associated with coagulation disorders, in particular high levels of D-dimers, and increased frequency of venous thromboembolism (VTE). We explore the association between D-dimers at admission and in-hospital mortality in hospitalized COVID-19 patients with or without symptomatic VTE.Methods: From February 26 to April 20, 2020, D-dimer level at admission and outcomes of patients hospitalized for COVID-19 in medical wards (in-hospital mortality or VTE) were retrospectively analyzed in a multicenter study in 24 French hospitals.Results: Among 2878 patients enrolled in the study, 1154 (40.9%) patients had D-dimer measurement at admission. A receiver operating characteristic (ROC) curve analysis identified D-dimer level above 1128 ng/mL as the optimum cutoff value to predict in-hospital mortality (Area Under the Curve of 64.9% (95% CI 0.60–0.69) with a sensitivity of 71.1% (95% CI 0.62–0.78) and a specificity of 55.6% (95% CI 0.52–0.58) that not differ in the subgroup of patients with VTE during hospitalization. Among 609 (52.8%) patients with D-dimers level < 1128 ng/mL at admission, only 35 (5.7%) deaths occurred during hospitalization. After adjustment, in a cox proportional hazard and logistic regression models, D-dimers above 1128 ng/mL at admission were also associated to a worth prognosis with a OR of 3.07 (95% CI 2.05–4.69, p < 0.001) and an unadjusted hazard ratio of 2.11 (95%CI 1.31–3.4, p < 0.01).Conclusions: D-dimer level over 1128 ng/mL is a relevant predictive factor for in-hospital mortality in COVID-19 hospitalized patients in medical ward, regardless the occurrence of VTE during hospitalization.

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“…Although the SARS-CoV-2 detection of SARS-CoV-2 in post mortem tissue by transmission electron microscopy is a challenging task (4), replicated virus-like particles were observed enveloped in endothelial cells (1,5), lymphatic cells (6) , but also in type 2 and 1 pneumocytes (6,7). (8,9). Viral-associated thrombotic microangiopathies have been described in numerous inflammatory cardiorespiratory diseases (e.g.…”

mentioning

confidence: 99%

Inflammation and intussusceptive angiogenesis in COVID-19: everything in and out of flow

et al. 2020

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Thrombosis and COVID-19 pneumonia: the clot thickens!

Cited by 170 publications

References 39 publications

Incidence of thromboembolism in patients with COVID-19: a systematic review and meta-analysis

Incidence of thromboembolism in patients with COVID-19: a systematic review and meta-analysis

D-dimers at hospital admission for COVID-19 are associated with in hospital mortality independently of venous thromboembolism: Insight from a French multicenter cohort study

Inflammation and intussusceptive angiogenesis in COVID-19: everything in and out of flow

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