COVID-19 and Thrombosis: Clinical Aspects

Abstract

In coronavirus disease 2019 [COVID-19], thrombus formation is related to the pathogenesis of acute respiratory distress syndrome [ARDS] and the progression of clinical symptoms. Severe damage to vascular endothelial cells and the associated cytokine storm after SARS-CoV-2 infection cause thrombogenesis and contribute to the development of more severe and unique thromboses compared to other infectious diseases. Thromboses occur more often in critically ill patients. In addition to pulmonary thromboembolism [PE] and deep vein thrombosis, acute myocardial infarction, peripheral arterial thrombosis, and aortic thrombosis have also been reported. In PE, thrombi develop in both pulmonary arteries and alveolar capillaries. These, together with intra-alveolar fibrin deposition, interfere with effective gaseous exchange in the lungs and exacerbate the clinical symptoms of ARDS in patients with COVID-19. Pharmacological thromboprophylaxis is recommended for all hospitalized patients to prevent both thrombosis and aggravation of ARDS, and other organ failures. Although the pediatric population is mostly asymptomatic or develops mild disease after SARS-CoV-2 infection, a new inflammatory disorder affecting the cardiovascular system, multisystem inflammatory syndrome in children [MIS-C], has been reported. Similar to Kawasaki disease, acute myocarditis, coronary vasculitis, and aneurysms are typically seen in MIS-C, although these two are now considered distinct entities. A similar acute myocarditis is also observed in young male adults, in which a hyperinflammatory state after SARS-CoV-2 infection seems to be involved. Several side effects following vaccination against COVID-19 have been reported, including vaccine-induced immune thrombotic thrombocytopenia and acute myocarditis. Although these could be serious and life-threatening, the cases are very rare, thus, the benefits of immunization still outweigh the risks.

Role of PCSK9 inhibition during the inflammatory stage of SARS-COV-2: an updated review

“…Immune cells play a crucial role in orchestrating the immune response during viral infections. PCSK9 inhibition might modulate the immune response in a way that promotes tissue repair and resolution of inflammation, potentially protecting against ARDS 56 , 57 . Considering the potential involvement of PCSK9 in lung injury and inflammation, PCSK9 inhibition may hold promise as a therapeutic strategy to protect against ARDS in severe COVID-19 cases.…”

The impact of the COVID-19 pandemic on the incidence of myocardial infarctions: an overview of current research

“…SARS-CoV-2 can lead to increased expression of clotting factors and a simultaneous decrease in antithrombotic capabilities, which, combined with endothelial damage and vascular inflammation, creates favorable conditions for the formation of blood clots. These clots can subsequently block the coronary arteries, leading to a myocardial infarctions [26,27].…”