Systematic Reviews and Meta Analysis
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COVID-19 and its implications for thrombosis

Year 2021, Volume: 3 Issue: 2, 37 - 39, 29.04.2021
https://doi.org/10.46310/tjim.851367

Abstract

COVID-19 is a systemic infection with a significant impact on the hematopoietic system and hemostasis. Reported findings indicate that immunosuppression, endothelial activation, and direct viral-mediated tissue damage rather than hyperinflammation-related injury mediates COVID-19 induced organ dysfunction. If direct infection drives injury, the vascular tissue is expected to be quite susceptible as it highly expresses angiotensin-converting enzyme-2 (ACE-2), which is essential for coronavirus uptake. Viral injury, disordered cytokine release, and damage-associated molecular patterns (DAMPs) induce localized microvascular inflammation, which triggers endothelial activation, leading to vasodilation and pro-thrombotic conditions. It has been shown that lymphocytes express the ACE-2 receptor on their surfaces thus, SARS-CoV-2 may directly infect those cells and ultimately lead to their lysis. Furthermore, the cytokine storm is characterized by markedly increased levels of interleukins and TNF –alpha, which may promote lymphocyte apoptosis. Apoptosis mediates lymphocyte depletion and inhibitory effects of lactic acid on lymphocyte proliferation.

References

  • 1. Leisman DE, Deutschman CS, Legrand M. Facing COVID-19 in the ICU: vascular dysfunction, thrombosis, and dysregulated inflammation. Intensive Care Med. 2020 Jun;46(6):1105-8. doi: 10.1007/s00134-020-06059-6.
  • 2. Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, Vanstapel A, Werlein C, Stark H, Tzankov A, Li WW, Li VW, Mentzer SJ, Jonigk D. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med. 2020 Jul 9;383(2):120-8. doi: 10.1056/NEJMoa2015432.
  • 3. Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, Bikdeli B, Ahluwalia N, Ausiello JC, Wan EY, Freedberg DE, Kirtane AJ, Parikh SA, Maurer MS, Nordvig AS, Accili D, Bathon JM, Mohan S, Bauer KA, Leon MB, Krumholz HM, Uriel N, Mehra MR, Elkind MSV, Stone GW, Schwartz A, Ho DD, Bilezikian JP, Landry DW. Extrapulmonary manifestations of COVID-19. Nat Med. 2020 Jul;26(7):1017-32. doi: 10.1038/s41591-020-0968-3.
  • 4. Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, Psaltopoulou T, Gerotziafas G, Dimopoulos MA. Hematological findings and complications of COVID-19. Am J Hematol. 2020 Jul;95(7):834-47. doi: 10.1002/ajh.25829.
  • 5. Levi M, Hunt BJ. Thrombosis and coagulopathy in COVID-19: An illustrated review. Res Pract Thromb Haemost. 2020 Jul 11;4(5):744-51. doi: 10.1002/rth2.12400.
  • 6. Cuker A, Peyvandi F. Coronavirus disease 2019 (COVID-19): Hypercoagulability. UpToDate 2020. Available at: https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-hypercoagulability. Accessed October 27, 2020.
  • 7. Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, Nigoghossian C, et.al.; Global COVID-19 Thrombosis Collaborative Group, Endorsed by the ISTH, NATF, ESVM, and the IUA, Supported by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function. COVID-19 and thrombotic or thromboembolic disease: Implications for prevention, antithrombotic therapy, and follow-up: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Jun 16;75(23):2950-73. doi: 10.1016/j.jacc.2020.04.031.
  • 8. Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020 Jun;7(6):e438-40. doi: 10.1016/S2352-3026(20)30145-9.
  • 9. Chan NC, Weitz JI. COVID-19 coagulopathy, thrombosis, and bleeding. Blood. 2020 Jul 23;136(4):381-3. doi: 10.1182/blood.2020007335.
  • 10. Ramos RP, Ota-Arakaki JS. Thrombosis and anticoagulation in COVID-19. J Bras Pneumol. 2020;46(4):e20200317. doi: 10.36416/1806-3756/e20200317.
  • 11. Allegra A, Innao V, Allegra AG, Musolino C. Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies. Ann Hematol. 2020 Sep;99(9):1953-65. doi: 10.1007/s00277-020-04182-4.
  • 12. Miesbach W, Makris M. COVID-19: Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation. Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620938149. doi: 10.1177/1076029620938149.
  • 13. Tal S, Spectre G, Kornowski R, Perl L. Venous thromboembolism complicated with COVID-19: What do we know so far? Acta Haematol. 2020;143(5):417-424. doi: 10.1159/000508233.
  • 14. Wichmann D, Sperhake JP, Lütgehetmann M, Steurer S, Edler C, Heinemann A, Heinrich F, Mushumba H, Kniep I, Schröder AS, Burdelski C, de Heer G, Nierhaus A, Frings D, Pfefferle S, Becker H, Bredereke-Wiedling H, de Weerth A, Paschen HR, Sheikhzadeh-Eggers S, Stang A, Schmiedel S, Bokemeyer C, Addo MM, Aepfelbacher M, Püschel K, Kluge S. Autopsy findings and venous thromboembolism in patients with COVID-19: A Prospective Cohort Study. Ann Intern Med. 2020 Aug 18;173(4):268-77. doi: 10.7326/M20-2003.
  • 15. Li Y, Xu Y, Shi P, Zhu Y, Hu W, Chen C. Antiplatelet/anticoagulant agents for preventing thrombosis events in patients with severe COVID-19: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2020 Aug 7;99(32):e21380. doi: 10.1097/MD.0000000000021380.
  • 16. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020 Jun 4;135(23):2033-40. doi: 10.1182/blood.2020006000.
  • 17. Fontana P, Casini A, Robert-Ebadi H, Glauser F, Righini M, Blondon M. Venous thromboembolism in COVID-19: systematic review of reported risks and current guidelines. Swiss Med Wkly. 2020 Jun 21;150:w20301. doi: 10.4414/smw.2020.20301.
  • 18. Unuvar A. COVID-19 and coagulopathy. Sağlık Bilimlerinde İleri Araştırmalar Dergisi 2020; 3(Suppl.1):S53-S62 (in Turkish). doi.org/10.26650/JARHS2020-S1-0007.
  • 19. Barco S, Konstantinides SV; CORE‐THROMBOSIS Investigators. Thrombosis and thromboembolism related to COVID-19: A clarion call for obtaining solid estimates from large-scale multicenter data. Res Pract Thromb Haemost. 2020 Jun 12;4(5):741-3. doi: 10.1002/rth2.12364.
Year 2021, Volume: 3 Issue: 2, 37 - 39, 29.04.2021
https://doi.org/10.46310/tjim.851367

Abstract

References

  • 1. Leisman DE, Deutschman CS, Legrand M. Facing COVID-19 in the ICU: vascular dysfunction, thrombosis, and dysregulated inflammation. Intensive Care Med. 2020 Jun;46(6):1105-8. doi: 10.1007/s00134-020-06059-6.
  • 2. Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, Vanstapel A, Werlein C, Stark H, Tzankov A, Li WW, Li VW, Mentzer SJ, Jonigk D. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med. 2020 Jul 9;383(2):120-8. doi: 10.1056/NEJMoa2015432.
  • 3. Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, Bikdeli B, Ahluwalia N, Ausiello JC, Wan EY, Freedberg DE, Kirtane AJ, Parikh SA, Maurer MS, Nordvig AS, Accili D, Bathon JM, Mohan S, Bauer KA, Leon MB, Krumholz HM, Uriel N, Mehra MR, Elkind MSV, Stone GW, Schwartz A, Ho DD, Bilezikian JP, Landry DW. Extrapulmonary manifestations of COVID-19. Nat Med. 2020 Jul;26(7):1017-32. doi: 10.1038/s41591-020-0968-3.
  • 4. Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, Psaltopoulou T, Gerotziafas G, Dimopoulos MA. Hematological findings and complications of COVID-19. Am J Hematol. 2020 Jul;95(7):834-47. doi: 10.1002/ajh.25829.
  • 5. Levi M, Hunt BJ. Thrombosis and coagulopathy in COVID-19: An illustrated review. Res Pract Thromb Haemost. 2020 Jul 11;4(5):744-51. doi: 10.1002/rth2.12400.
  • 6. Cuker A, Peyvandi F. Coronavirus disease 2019 (COVID-19): Hypercoagulability. UpToDate 2020. Available at: https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-hypercoagulability. Accessed October 27, 2020.
  • 7. Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, Nigoghossian C, et.al.; Global COVID-19 Thrombosis Collaborative Group, Endorsed by the ISTH, NATF, ESVM, and the IUA, Supported by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function. COVID-19 and thrombotic or thromboembolic disease: Implications for prevention, antithrombotic therapy, and follow-up: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Jun 16;75(23):2950-73. doi: 10.1016/j.jacc.2020.04.031.
  • 8. Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020 Jun;7(6):e438-40. doi: 10.1016/S2352-3026(20)30145-9.
  • 9. Chan NC, Weitz JI. COVID-19 coagulopathy, thrombosis, and bleeding. Blood. 2020 Jul 23;136(4):381-3. doi: 10.1182/blood.2020007335.
  • 10. Ramos RP, Ota-Arakaki JS. Thrombosis and anticoagulation in COVID-19. J Bras Pneumol. 2020;46(4):e20200317. doi: 10.36416/1806-3756/e20200317.
  • 11. Allegra A, Innao V, Allegra AG, Musolino C. Coagulopathy and thromboembolic events in patients with SARS-CoV-2 infection: pathogenesis and management strategies. Ann Hematol. 2020 Sep;99(9):1953-65. doi: 10.1007/s00277-020-04182-4.
  • 12. Miesbach W, Makris M. COVID-19: Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation. Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620938149. doi: 10.1177/1076029620938149.
  • 13. Tal S, Spectre G, Kornowski R, Perl L. Venous thromboembolism complicated with COVID-19: What do we know so far? Acta Haematol. 2020;143(5):417-424. doi: 10.1159/000508233.
  • 14. Wichmann D, Sperhake JP, Lütgehetmann M, Steurer S, Edler C, Heinemann A, Heinrich F, Mushumba H, Kniep I, Schröder AS, Burdelski C, de Heer G, Nierhaus A, Frings D, Pfefferle S, Becker H, Bredereke-Wiedling H, de Weerth A, Paschen HR, Sheikhzadeh-Eggers S, Stang A, Schmiedel S, Bokemeyer C, Addo MM, Aepfelbacher M, Püschel K, Kluge S. Autopsy findings and venous thromboembolism in patients with COVID-19: A Prospective Cohort Study. Ann Intern Med. 2020 Aug 18;173(4):268-77. doi: 10.7326/M20-2003.
  • 15. Li Y, Xu Y, Shi P, Zhu Y, Hu W, Chen C. Antiplatelet/anticoagulant agents for preventing thrombosis events in patients with severe COVID-19: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2020 Aug 7;99(32):e21380. doi: 10.1097/MD.0000000000021380.
  • 16. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020 Jun 4;135(23):2033-40. doi: 10.1182/blood.2020006000.
  • 17. Fontana P, Casini A, Robert-Ebadi H, Glauser F, Righini M, Blondon M. Venous thromboembolism in COVID-19: systematic review of reported risks and current guidelines. Swiss Med Wkly. 2020 Jun 21;150:w20301. doi: 10.4414/smw.2020.20301.
  • 18. Unuvar A. COVID-19 and coagulopathy. Sağlık Bilimlerinde İleri Araştırmalar Dergisi 2020; 3(Suppl.1):S53-S62 (in Turkish). doi.org/10.26650/JARHS2020-S1-0007.
  • 19. Barco S, Konstantinides SV; CORE‐THROMBOSIS Investigators. Thrombosis and thromboembolism related to COVID-19: A clarion call for obtaining solid estimates from large-scale multicenter data. Res Pract Thromb Haemost. 2020 Jun 12;4(5):741-3. doi: 10.1002/rth2.12364.
There are 19 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section Reviews
Authors

Vildan Ozkocaman 0000-0003-0014-7398

Publication Date April 29, 2021
Submission Date December 29, 2020
Acceptance Date January 15, 2021
Published in Issue Year 2021 Volume: 3 Issue: 2

Cite

EndNote Ozkocaman V (April 1, 2021) COVID-19 and its implications for thrombosis. Turkish Journal of Internal Medicine 3 2 37–39.

e-ISSN: 2687-4245 

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