Hyperthrombotic Milieu in COVID-19 Patients
Name
cells-09-02392-v2.pdf
Size
1.3 MB
Format
Adobe PDF
Checksum (MD5)
a316da371d05bbf08e6ca51ac9b372e9
Author(s)
Kamel, Mohamed Hassan
Yin, Wenqing
Zavaro, Chris
Francis, Jean M.
Chitalia, Vipul C.
Date Issued
October 2020
Journal
Cells
Publisher
MDPI AG
Citation
Kamel, Mohamed Hassan et al. "Hyperthrombotic Milieu in COVID-19 Patients." Cells 9, 11 (October 2020): 2392 © 2020 The Authors
Version
Final published version
Abstract
COVID-19 infection has protean systemic manifestations. Experience from previous coronavirus outbreaks, including the current SARS-CoV-2, has shown an augmented risk of thrombosis of both macrovasculature and microvasculature. The former involves both arterial and venous beds manifesting as stroke, acute coronary syndrome and venous thromboembolic events. The microvascular thrombosis is an underappreciated complication of SARS-CoV-2 infection with profound implications on the development of multisystem organ failure. The telltale signs of perpetual on-going coagulation and fibrinolytic cascades underscore the presence of diffuse endothelial damage in the patients with COVID-19. These parameters serve as strong predictors of mortality. While summarizing the alterations of various components of thrombosis in patients with COVID-19, this review points to the emerging evidence that implicates the prominent role of the extrinsic coagulation cascade in COVID-19-related coagulopathy. These mechanisms are triggered by widespread endothelial cell damage (endotheliopathy), the dominant driver of macro- and micro-vascular thrombosis in these patients. We also summarize other mediators of thrombosis, clinically relevant nuances such as the occurrence of thromboembolic events despite thromboprophylaxis (breakthrough thrombosis), current understanding of systemic anticoagulation therapy and its risk–benefit ratio. We conclude by emphasizing a need to probe COVID-19-specific mechanisms of thrombosis to develop better risk markers and safer therapeutic targets.
MIT Department
Massachusetts Institute of Technology. Institute for Medical Engineering & Science
Harvard University--MIT Division of Health Sciences and Technology
Terms of Use
Creative Commons Attribution 4.0 International license
Persistent DSpace Link
DOI of Published Version
https://doi.org/10.3390/cells9112392
