Venous Thromboembolism in COVID-19 Compared to Non-COVID-19 Cohorts: A Systematic Review with Meta-Analysis

Tufano, Antonella; Rendina, Domenico; Abate, Veronica; Casoria, Aniello; Marra, Annachiara; Buonanno, Pasquale; Galletti, Ferruccio; Minno, Giovanni Di; Servillo, Giuseppe; Vargas, Maria

doi:10.3390/jcm10214925

Cited by 34 publications

(32 citation statements)

References 43 publications

(94 reference statements)

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“…This is in contrast to our STEMI patients, who can be treated by CRP apheresis via peripheral access [ 12 – 14 ]. This clotting is probably due to the known hypercoagulability in COVID-19 [ 24 ], and may also be caused by hemodynamic centralization in these severely ill patients. Thus, we now use Shaldon catheters for CRP apheresis in our COVID patients.…”

Section: Discussionmentioning

confidence: 99%

A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV) Registry

Schümann¹,

Heigl

Rohrbach

et al. 2021

Am J Case Rep

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Case series Patients: 7 Final Diagnosis: COVID-19 disease Symptoms: Fever • dypspnea Medication: Standard of care Clinical Procedure: C-reactive protein apheresis Specialty: Immunology • Infectious Diseases Objective: Unusual clinical course Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced pneumonia is a disease with high mortality and, still, no effective treatment. Excessively elevated C-reactive protein (CRP) plasma levels inversely correlate with prognosis. As CRP, via complement and macrophage activation, can cause organ damage in COVID-19, we have recently introduced selective CRP apheresis as a potentially effective treatment. Now, we report on the first patients with severe SARS-CoV-2-induced pneumonia treated within the “ C -reactive protein A pheresis in COV ID” ( CACOV ) registry. Case Reports: Seven sequential hospitalized patients with documented COVID-19, strongly elevated CRP plasma levels, and respiratory failure were treated by selective CRP apheresis in addition to standard therapy after having given their informed consent for inclusion in the CACOV registry. We performed 2-8 CRP apheresis sessions via either peripheral or central venous access depending on clinical course and CRP plasma levels. CRP apheresis, in COVID-19, reduced CRP plasma levels by approximately 50–90%, and it was thus highly effective, feasible, and safe. Despite severe radiological lung involvement in all our patients, only 2 patients finally required intubation, and none required extracorporeal membrane oxygenation (ECMO). All 7 patients were discharged from our 2 hospitals in good clinical condition. Conclusions: Selective CRP apheresis, starting early after patient admission, may be an effective treatment of SARS-CoV-2-induced pneumonia. SARS-COV-2 can cause organ damage and multiple organ failure predominantly by an excessive CRP-mediated autoimmune response of the ancient innate immune system. Further registry data and randomized trials are needed.

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Section: Discussionmentioning

confidence: 99%

A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV) Registry

Schümann¹,

Heigl

Rohrbach

et al. 2021

Am J Case Rep

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“…A recent meta-analysis revealed an estimated venous thromboembolism (VTE) rate of 25%, with higher incidence in severe cases, such as those who are on mechanical ventilation [ 24 ]. The risk for VTE in COVID-19 compared to non-COVID-19 (other respiratory tract infections including H1N1) patients was 6% higher in general and the risk increased further to 16% in ICU patients when these two categories were compared [ 25 ]. Furthermore, the number of ischemic strokes' reports during COVID-19 infection is increasing [ 26 , 27 ].…”

Section: Pathophysiology Of Covid-19-associated Coagulopathymentioning

confidence: 99%

COVID-19 Coagulopathy: From Pathogenesis to Treatment

et al. 2022

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Coronavirus disease 2019 (COVID-19) has emerged as a pandemic at the end of 2019 and continues to exert an unfavourable worldwide health impact on a large proportion of the population. A remarkable feature of COVID-19 disease is the precipitation of a hypercoagulable state, mainly in severe cases, leading to micro- and macrothrombosis, respiratory failure and death. Despite the implementation of various therapeutic regimes, including anticoagulants, a large number of patients suffer from such serious complications. This review aims to describe the current knowledge on the pathophysiology of the coagulation mechanism in COVID-19. We describe the interplay between three important mediators of the disease and how this may lead to a hyperinflammatory and pro-thrombotic state that affects outcome; namely, the endothelium, the immune system and the coagulation system. In line with the hypercoagulability state during COVID-19, we further review on the rare but severe vaccine-induced thrombotic thrombocytopenia. We also summarize and comment on available anticoagulant treatment options and include suggestions for some future treatment considerations for COVID-19 anti-coagulation therapy.

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“…When comparing COVID-19 patients to non-COVID-19 patients, an elevated risk of venous thromboembolism has been shown. It has been reported that critically ill COVID-19 patients have a 16% higher risk of developing venous thromboembolism when compared to non-COVID-19 patients [6]. There are several possible explanations for this.…”

Section: Introductionmentioning

confidence: 98%

The Incidence of Venous Thromboembolism in Critically Ill Patients with SARS-CoV-2 Infection Compared with Critically Ill Influenza and Community-Acquired Pneumonia Patients: A Retrospective Chart Review

et al. 2022

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The rate of venous thromboembolism in COVID-19 patients has been reported to be 30% (deep vein thrombosis 20% and pulmonary embolism 18%). This has been shown to be higher in COVID-19 patients admitted to the ICU. Prophylactic anticoagulation may be sufficient at ward level, but not in intensive care. A retrospective chart review was undertaken in a large university hospital. The review included 276 patients from COVID-19 Wave 1, COVID-19 Wave 2, influenza, and community-acquired pneumonia groups. The timeframe included patients admitted between 23 February 2014 and 12 May 2021. Clinical characteristics, outcomes, blood results, rates of venous thromboembolism, and anticoagulation status were recorded. The incidence of venous thromboembolism in COVID-19 Wave 1, COVID-19 Wave 2, influenza, and community-acquired pneumonia was 10.91%, 13.69%, 13.33%, and 6.81%, respectively (p = 0.481). The incidence of pulmonary embolism was 7.27%, 10.95%, 3.33%, and 5.68%, respectively (p = 0.350). The incidence of deep vein thrombosis was 5.45%, 5.48%, 10.00%, and 1.14%, respectively (p = 0.117). Although most patients were prophylactically anticoagulated, venous thromboembolism still occurred. Venous thromboembolism remains an important differential to consider in critically ill COVID-19 patients. The current literature does not advise therapeutic anticoagulation for thromboprophylaxis in the ICU.

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Venous Thromboembolism in COVID-19 Compared to Non-COVID-19 Cohorts: A Systematic Review with Meta-Analysis

Cited by 34 publications

References 43 publications

A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV) Registry

A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV) Registry

COVID-19 Coagulopathy: From Pathogenesis to Treatment

The Incidence of Venous Thromboembolism in Critically Ill Patients with SARS-CoV-2 Infection Compared with Critically Ill Influenza and Community-Acquired Pneumonia Patients: A Retrospective Chart Review

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