Haematological manifestations, mechanisms of thrombosis and anti-coagulation in COVID-19 disease: A review

Kasinathan, Ganesh; Sathar, Jameela

doi:10.1016/j.amsu.2020.06.035

Cited by 33 publications

(38 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…SARS-CoV-2 has been found to cause a prothrombotic state which long-term outcomes remain unknown. [9][10][11] Accordingly, macroscopic lesions were expected to be found in the retina. Subjects requiring admission in ICU, who received treatment with anticoagulant drugs and mechanical ventilation, were expected to show small haemorrhages or cotton wool exudates from small infarcts in the nerve fibre layer.…”

Section: Discussionmentioning

confidence: 99%

Retinal microvascular abnormalities in patients after COVID-19 depending on disease severity

et al. 2020

View full text Add to dashboard Cite

BackgroundGlobal pandemic SARS-CoV-2 causes a prothrombotic state without fully elucidated effects. This study aims to analyse and quantify the possible retinal microvascular abnormalities.Materials and methodsCase–control study. Patients between 18 and 55 years old with PCR-confirmed SARS-CoV-2 infection within the last 3 months were included. Risk stratification: group 1—mild disease (asymptomatic/paucisymptomatic); group 2—moderate disease (required hospital admission with no acute respiratory distress) and group 3—severe disease (subjects who developed an acute respiratory distress were admitted in the intensive care unit and presented interleukin 6 values above 40 pg/mL). Age-matched volunteers with negative serology tests were enrolled to control group. A colour photograph, an optical coherence tomography (OCT) and an angiography using OCT centred on the fovea were performed.ResultsControl group included 27 subjects: group 1 included 24 patients, group 2 consisted of 24 patients and 21 participants were recruited for group 3. There were no funduscopic lesions, neither in the colour images nor in the structural OCT. Fovea-centred vascular density (VD) was reduced in group 2 and group 3 compared with group 1 and control group (control group vs group 2; 16.92 vs 13.37; p=0.009) (control group vs group 3; 16.92 vs .13.63; p=0.026) (group 1 vs group 2; 17.16 vs 13.37; p=0.006) (group 1 vs group 3; 17.16 vs 13.63 p=0.017).ConclusionPatients with moderate and severe SARS-CoV-2 pneumonia had decreased central retinal VD as compared with that of asymptomatic/paucisymptomatic cases or control subjects.

show abstract

Section: Discussionmentioning

confidence: 99%

Retinal microvascular abnormalities in patients after COVID-19 depending on disease severity

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The factors, which might explain the association between VTE and COVID-19 infection, are inflammation and hypercoagulability triggered by SARS-CoV-2 virus. 13 , 14 Regarding the mechanisms involved, the activation and endothelial cell damage resulting from the binding of angiotensin-converting enzyme 2 receptors to the virus may increase the risk of VTE mediated by the release of inflammatory cytokines such as interleukin (IL)-6, IL-2, IL-7, granulocyte colony stimulating factor, interferon-γ, and TNF-α. 13–15 This mechanism could play an important role in the activation of coagulation, increased blood viscosity, and micro-vascular thrombosis, although this is yet an area under study.…”

Section: Discussionmentioning

confidence: 99%

“… 13–15 This mechanism could play an important role in the activation of coagulation, increased blood viscosity, and micro-vascular thrombosis, although this is yet an area under study. 13 , 14 This would explain the coagulation profile abnormalities found in patients with SARS-CoV-2 infection, including elevated levels of D-dimer, fibrinogen, fibrin, and fibrinogen degradation products, as well as decreased levels of antithrombin. 13 , 14 A recently published study showed an increase in platelet activation and aggregation in patients infected with SARS-CoV-2, which could also contribute to thromboinflammation in this disease.…”

Section: Discussionmentioning

confidence: 99%

“… 13 , 14 This would explain the coagulation profile abnormalities found in patients with SARS-CoV-2 infection, including elevated levels of D-dimer, fibrinogen, fibrin, and fibrinogen degradation products, as well as decreased levels of antithrombin. 13 , 14 A recently published study showed an increase in platelet activation and aggregation in patients infected with SARS-CoV-2, which could also contribute to thromboinflammation in this disease. 15 This suggests that one of the potential mechanisms of VTE in our patient could have been caused by SARS-CoV-2 virus triggered inflammation, even in this case with mild symptoms of COVID-19 infection at presentation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Acute pulmonary embolism in a patient with mild COVID-19 symptoms: a case report

Fiorini¹,

Garagoli²,

Bustamante³

et al. 2021

European Heart Journal - Case Reports

View full text Add to dashboard Cite

Background The venous thromboembolism (VTE) is a frequent condition, which may worsen the prognosis of hospitalized COVID-19 patients. Nevertheless, the incidence of this complication is unknown in patients with mild COVID-19 symptoms. Case summary A 26-year-old female nurse, who had been taking oral contraceptive pills (OCPs) treatment for the last 2 years, developed mild COVID-19 symptoms (rhinitis and anosmia). She underwent isolation at home and was subsequently followed up with telehealth visits. Fifteen days after her initial presentation, she developed acute onset sudden dyspnoea. On physical examination, she was found to be tachycardic with normal pulse oximetry. The initial risk score for VTE was moderate and laboratory results showed increased D-dimer level without other relevant findings. Computed tomography pulmonary angiography was performed, which confirmed low-risk subsegmental pulmonary embolism. Discussion Venous thromboembolism in patients who present with severe COVID-19 symptoms has already been described in the literature; its incidence is greater in patients hospitalized in intensive care units. Efforts to prevent VTE based on risk scores are widely recognized. However, the relationship in patients who present with mild COVID-19 symptoms and VTE is still unknown. Recently, experts on this field have introduced thromboprophylaxis guidelines including ambulatory patients based on the severity of COVID-19 symptoms and pro-thrombotic risk. Our patient showed no major risk for developing VTE; therefore, the VTE could be associated with SARS-CoV-2 infection or the eventual pro-thrombotic association with the concomitant use of OCPs.

show abstract

“…Profound hypoxemia in the pulmonary capillaries may induce endothelial dysfunction and platelet dysfunction [24]. Endothelial cell injury activates a large number of pro-in ammatory cytokines, contributing to microvascular thrombosis including plugging of the pulmonary microvasculature and the occurrence of VTE [25,26]. A better knowledge of the pathogenesis of abnormal coagulation in COVID-19 patients is urgently needed to provide the potential basis of targeted treatments.…”

Section: Discussionmentioning

confidence: 99%

High Incidence of Venous Thromboembolism in Patients with Coronavirus Disease 2019: A Call for Improved Awareness and Prevention

Zhang¹,

Zhang²,

Wang³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: An increased risk of venous thromboembolism (VTE) in patients with coronavirus disease 2019 (COVID-19) has been reported. We performed a meta-analysis to evaluate the prevalence of VTE in COVID-19 patients.Methods: The PubMed and Embase databases were searched for studies reporting VTE in COVID-19 patients up to June 27, 2020. The selected studies were predefined into the “suspected screening group” and the “routine screening group.” The VTE prevalence was calculated using random-effect models.Results: We selected 20 studies including a total of 2763 COVID-19 patients. In 2203 COVID-19 patients from the suspected screening group, the pool VTE incidence was 15.2% (95% confidence interval [CI]: 10.5–21.6%). In 560 COVID-19 patients from the routine screening group, the VTE prevalence was 40.8% (95% CI: 20.6–64.7%). Furthermore, the VTE incidence of critically ill COVID-19 patients from the two groups was 19.6% and 61.4%, respectively, which indicates that critically ill COVID-19 patients were more susceptible to VTE.Conclusions: A high incidence of VTE was observed in COVID-19 patients, especially in severe cases. The incidence of VTE in COVID-19 patients from the routine screening group was higher than that in patients from the suspected screening group. This indicates that a lower threshold of suspicion to perform VTE imaging tests may be reasonable and there is an urgent need to adapt a regular screening strategy for VTE.

show abstract

Haematological manifestations, mechanisms of thrombosis and anti-coagulation in COVID-19 disease: A review

Cited by 33 publications

References 33 publications

Retinal microvascular abnormalities in patients after COVID-19 depending on disease severity

Retinal microvascular abnormalities in patients after COVID-19 depending on disease severity

Acute pulmonary embolism in a patient with mild COVID-19 symptoms: a case report

High Incidence of Venous Thromboembolism in Patients with Coronavirus Disease 2019: A Call for Improved Awareness and Prevention

Contact Info

Product

Resources

About