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COVID-19, immunothrombosis and venous thromboembolism: biological mechanisms

Joan Loo1, Daniella A Spittle2, Michael Newnham3

  • 1College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.

Thorax
|January 7, 2021
PubMed

Insights

COVID-19 frequently causes venous thromboemboli (VTE) and microvascular issues due to inflammation and coagulopathy. Understanding immunothrombosis mechanisms is key to developing treatments for these thrombotic events.

Area of Science:

  • Cardiovascular Medicine
  • Hematology
  • Immunology

Background:

  • COVID-19 is linked to a high incidence of thrombotic events, primarily venous thromboemboli (VTE).
  • Disease severity correlates with VTE occurrence and poorer clinical outcomes.
  • Microvascular abnormalities, including endothelial inflammation and microthrombi, are characteristic of severe COVID-19.

Purpose of the Study:

  • To review the pathobiological mechanisms underlying immunothrombosis and VTE in COVID-19.
  • To explore the intricate interplay between the hemostatic and immune systems in COVID-19-associated thrombosis.
  • To identify potential therapeutic targets for managing thrombotic complications.

Main Methods:

  • Comprehensive literature review of state-of-the-art research on COVID-19 and thrombosis.
  • Analysis of pathobiological mechanisms including coagulopathy, endothelial dysfunction, and immune system activation.
  • Examination of genetic associations and other contributing thrombotic factors.

Main Results:

  • COVID-19 features a distinct coagulopathy, elevated cytokines, and activation of platelets, endothelium, and complement.
  • A proinflammatory state can lead to dysregulated immunothrombosis, primarily affecting the microvasculature.
  • Multifactorial processes involving intricate links between hemostatic and immune systems contribute to VTE and immunothrombosis.

Conclusions:

  • Understanding the complex interplay of COVID-19-associated coagulopathy, endothelial dysfunction, and immune responses is crucial.
  • This knowledge is essential for developing and evaluating novel treatments for VTE and immunothrombosis.
  • Targeting these pathobiological mechanisms may improve clinical outcomes for patients with COVID-19.

Keywords:
cytokine biologyinnate immunitypulmonary embolismrespiratory infectionviral infection

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