The Pathobiological Basis for Thrombotic Complications in COVID-19: a Review of the Literature

Abstract

Purpose of Review COVID-19 has rapidly evolved into a global pandemic infecting over two hundred and forty-four million individuals to date. In addition to the respiratory sequelae and systemic infection that ensues, an alarming number of micro and macrovascular thrombotic complications have been observed. This review examines the current understanding of COVID-19-associated thrombotic complications, potential mechanisms, and pathobiological basis for thromboses development. Recent Findings The endothelium plays a major role in the process due to direct and indirect injury. The immune system also contributes to a pro-thrombotic environment with immune cell dysregulation leading to excessive formation of cytokines, also called cytokine storm, and an eventual promotion of a hypercoagulable environment, known as immunothrombosis. Additionally, neutrophils play an important role by forming neutrophil extracellular traps, which are shown to be pro-thrombotic and further enhanced in COVID-19 patients. A disruption of the fibrinolysis system has also been observed. Summary Multiple pathways likely contribute synergistically to form a pro-thrombotic milieu. A better understanding of these factors and the complex interplay between them will lead to the improvement of diagnostic and therapeutic interventions.

Gene Networks of Hyperglycemia, Diabetic Complications, and Human Proteins Targeted by SARS-CoV-2: What Is the Molecular Basis for Comorbidity?

“…Therefore, it could be speculated that the suppression of HO- The PLAT gene was found in the networks of hyperglycemia, CVD, diabetic neuropathy, and retinopathy. This is consistent with data on the important role of fibrinolysis disorders in the development of diabetic vascular complications [211] and COVID-19 [212].…”

The Incidence of Venous Thromboembolism in Critically Ill Patients with SARS-CoV-2 Infection Compared with Critically Ill Influenza and Community-Acquired Pneumonia Patients: A Retrospective Chart Review

“…SARS-CoV-2 infection has also been reported to cause pulmonary vascular endothelial inflammation and subsequent thrombosis [13][14][15][16][17][18]. It has been described as causing an inflammatory, prothrombotic, hypofibrinolytic state [19,20]. However, this is possibly the case in all viral infections [21].…”

Exploring the Synergistic Potential of Radiomics and Laboratory Biomarkers for Enhanced Identification of Vulnerable COVID-19 Patients

“…Concerning the prognostic value of initial routine laboratory values, the prognostic value of D-dimers has been described extensively [ 23 , 24 ]. Initial hypercoagulability with the transition to the consumptive stage of disseminated intravascular coagulopathy (DIC) has been reported [ 25 , 26 , 27 ]. Moreover, Gatto et al showed a frequent occurrence of pulmonary embolism between days 1 and 47 of hospitalization, occurring in the majority on day 10 [ 27 ].…”