COVID‐19 critical illness pathophysiology driven by diffuse pulmonary thrombi and pulmonary endothelial dysfunction responsive to thrombolysis

Poor, Hooman; Ventetuolo, Corey E.; Tolbert, Thomas; Chun, Glen; Serrao, Gregory; Zeidman, Amanda Dijanic; Dangayach, Neha; Olin, Jeffrey W.; Kohli‐Seth, Roopa; Powell, Charles A.

doi:10.1002/ctm2.44

Cited by 115 publications

(118 citation statements)

References 8 publications

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“…According to several publications, clotting plays a major role in disease severity and mortality. 12,13 In addition to arterial clots, others have observed high rates of venous thromboembolism in critically ill patients who otherwise lack the classic risk factors for venous thromboembolism. 10 A postmortem examination of 1 patient with severe COVID-19 disease revealed numerous pulmonary microthrombi.…”

Section: Discussionmentioning

confidence: 99%

Neurovascular Complications in COVID-19 Infection: Case Series

Franceschi¹,

Arora

Wilson

et al. 2020

AJNR Am J Neuroradiol

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We present a series of 10 hospitalized patients with confirmed coronavirus 2019 infections who developed severe neurovascular complications and discuss the possible reasons for these findings and their relationship to the novel Severe Acute Respiratory Syndrome coronavirus 2 infection. ABBREVIATIONS: ACE2 ¼ angiotensin-converting enzyme 2; COVID-19 ¼ coronavirus 2019; CRP ¼ C-reactive protein; CSS ¼ cytokine storm syndrome; ICU ¼ intensive care unit; LDH ¼ lactate dehydrogenase; PCR ¼ polymerase chain reaction; SARS-CoV-2 ¼ Severe Acute Respiratory Syndrome coronavirus 2 C oronavirus disease 2019 (COVID-19) is a predominantly acute respiratory disease caused by the novel Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). 1 In addition to progressive atypical respiratory system distress, other organ systems including the CNS may be affected in part due to the marked affinity of the virus for the angiotensin-converting enzyme 2 (ACE2) receptors. 2,3 Furthermore, a subgroup of patients with severe COVID-19 develop cytokine storm syndrome (CSS), characterized by hyperinflammation due to rapid accumulation of T-cells and macrophages, resulting in the release of massive levels of cytokines into the bloodstream to eliminate the offending pathogen, causing numerous clinical manifestations including atypical respiratory system distress and fever, progressing to widespread multiorgan dysfunction. 4-7 An increasingly recognized feature of COVID-19 infection is a thromboembolic diathesis, often resulting in brain ischemia, even in young patients despite anticoagulation/antiplatelet treatment. The comorbidity of pneumonia and thromboembolic complications in patients with COVID-19 may be explained, in part, by a causal relationship of severe inflammation and infection as precipitating factors. 6-8 Here, we present the neurovascular complications in 10 hospitalized patients with COVID-19 infection at our institutions. Available neuroimaging studies including head CT, head and neck CTA, and brain MR imaging were reviewed. Case Reports

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Section: Discussionmentioning

confidence: 99%

Neurovascular Complications in COVID-19 Infection: Case Series

Franceschi¹,

Arora

Wilson

et al. 2020

AJNR Am J Neuroradiol

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“…Such mechanisms include an imbalance between angiotensin II and angiotensin 1–7 via ACE2 sequestration producing a hypercoagulable state, cytokine release syndrome inducing plaque rupture, as well as direct and indirect cardiac effects. 16–24 Given the increased incidence of LVO without intracranial atherosclerosis, we entertain the theory of cardioembolic causes including paroxysmal atrial fibrillation triggered by the infection. Ten per cent of our patients had recurrent strokes during the same hospitalisation compared with the 0.8% previously reported.…”

Section: Discussionmentioning

confidence: 99%

Stroke in COVID-19: a single-centre initial experience in a hotspot of the pandemic

et al. 2020

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BackgroundCOVID-19, caused by SARS-CoV-2, is a global pandemic that has been an immense burden on healthcare systems all over the world. These patients may be at higher risk for acute ischaemic stroke (AIS). We present our experience with AIS in patients with COVID-19.MethodsWe reviewed all patients admitted to our hospital during a 6-week period with a positive nasopharyngeal swab test for SARS-CoV-2. Among these patients, we identified AIS. We reviewed the demographics, clinical, laboratory, imaging characteristics, treatments received and outcomes of AIS in patients with COVID-19.ResultsWe identified 683 patients admitted with COVID-19 during the study period, of which 20 patients had AIS. Large-vessel occlusion (LVO) was noted in 11 patients (55%). Intravenous alteplase was administered in four patients (20%) and mechanical thrombectomy was performed in five patients (25%). Respiratory symptoms preceded the onset of AIS in most of the patients (70%) by 1 to 21 days. Mortality in patients with AIS was 50% compared with 26% of all COVID-19 admissions. Most of these patients died due to non-neurological causes (70%). Three patients with AIS had clinical and imaging findings consistent with COVID-19, but were negative for multiple nasopharyngeal swab tests.InterpretationLVO was more common in patients with AIS and COVID-19. They had more severe disease and higher mortality rates. Most of the patients had respiratory symptoms preceding AIS by days to weeks. This could explain certain patients with clinical picture of COVID-19 but negative nasopharyngeal swab tests.

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“…These observations raise questions on the potential contributions of SCD‐related complications, for instance thromboembolism to the severity of COVID‐19. Increasing evidence suggests a higher risk of venous thromboembolism in COVID‐19, 3‐5 prompting ongoing considerations and potential applications of prophylactic anticoagulation 24 and therapeutic thrombolysis 25 …”

Section: Introductionmentioning

confidence: 99%

Sickle cell trait and the potential risk of severe coronavirus disease 2019—A mini‐review

Kehinde

Osundiji

2020

European J of Haematology

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Following the emergence of Coronavirus Disease 2019 (COVID-19) in Wuhan (China) around December 2019, 1 the infection has become a pandemic, decimating over three hundred thousand globally. 2 The severity of COVID-19 cases reported hitherto has varied greatly from asymptomatic to severe pneumonia and thromboembolism, accompanied by overt respiratory failure with subsequent mortality. 3-5 As the COVID-19 pandemic continues to evolve, potential risk factors that may predispose individuals to fatal outcomes are increasingly becoming topical. There are ongoing epidemiological investigations and discussions of potentially at-risk populations and ethnicities. 6,7 An improved understanding of the risk factors as well as clinical course for severe COVID-19 may shed some light on novel personalized approaches to optimize clinical care and outcomes. Emerging trends in the United States suggest possibly higher mortality rates of COVID-19 among African Americans, 8,9 although epidemiological study data with adequate denominator 10 across board is pending. There is no doubt that socioeconomic determinants of health play crucial roles in health inequities and disease trajectory. 11 Nevertheless, interplay of genetic and environmental factors contributes to overall clinical outcomes in a substantial burden of human diseases. 12-17 Sickle cell disease (SCD) disproportionately affects Black/ African Americans in the United States as well as forebearers from sub-Saharan Africa, the Western Hemisphere (South America, the Caribbean, and Central America), and some Mediterranean countries. 18-20 Increasing evidence suggests that COVID-19 pneumonia can cause acute chest syndrome (ACS), a potentially life-threatening complication in SCD. 21-23 These observations raise questions on the potential contributions of SCD-related complications, for instance

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COVID‐19 critical illness pathophysiology driven by diffuse pulmonary thrombi and pulmonary endothelial dysfunction responsive to thrombolysis

Cited by 115 publications

References 8 publications

Neurovascular Complications in COVID-19 Infection: Case Series

Neurovascular Complications in COVID-19 Infection: Case Series

Stroke in COVID-19: a single-centre initial experience in a hotspot of the pandemic

Sickle cell trait and the potential risk of severe coronavirus disease 2019—A mini‐review

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