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Thrombotic Complications in Patients with COVID-19: Pathophysiological Mechanisms, Diagnosis, and Treatment

Aleksandra Gąsecka1, Josip A Borovac2, Rui Azevedo Guerreiro3

  • 11st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. aleksandra.gasecka@wum.edu.pl.

Cardiovascular Drugs and Therapy
|October 19, 2020
PubMed

Insights

Severe COVID-19 increases the risk of both macrovascular and microvascular thromboembolism. Early recognition of coagulation abnormalities is critical for prognosis and guiding antithrombotic therapy in hospitalized patients.

Area of Science:

  • Thrombosis and Hemostasis
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Severe COVID-19 is linked to a higher risk of thromboembolism, affecting both macrovascular and microvascular systems.
  • Thrombotic complications, including venous thromboembolism, myocardial injury, and stroke, occur in one-third of hospitalized COVID-19 patients.
  • Autopsy findings reveal multiorgan damage consistent with microvascular injury in severe cases.

Purpose of the Study:

  • To review the mechanistic links between inflammation and thrombosis in COVID-19.
  • To discuss macrovascular and microvascular complications associated with COVID-19.
  • To summarize current approaches to prophylaxis, diagnosis, and treatment of thromboembolism in COVID-19 patients.

Main Methods:

  • Literature review of mechanistic relationships between inflammation and thrombosis.
  • Discussion of macrovascular and microvascular complications in COVID-19.
  • Summary of prophylaxis, diagnosis, and treatment strategies for thromboembolism.

Main Results:

  • COVID-19 associated coagulopathy presents with elevated D-dimers and normal coagulation times.
  • Distinguishing pulmonary embolism from severe COVID-19 is challenging due to overlapping symptoms.
  • Both macro- and microvascular complications correlate with increased in-hospital mortality.

Conclusions:

  • Guidelines recommend anticoagulation for hospitalized COVID-19 patients and post-discharge.
  • Individualized decisions are necessary for anticoagulant intensity and duration due to lack of specific guidance.
  • Early identification of coagulation abnormalities is crucial for improving patient outcomes.
Abstract

Keywords:
COVID-19InflammationProphylaxisSARS-CoV-2ThrombosisVenous thromboembolism

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