Venous and arterial thrombosis in COVID-19: An updated narrative review
Hospitalized patients with coronavirus disease 2019 (COVID-19), particularly those admitted to the intensive care unit (ICU) are at high risk of morbidity and mortality. Several observational studies have described hemostatic derangements and thrombotic complications in patients with COVID-19. The a...
| Principais autores: | , , , , , , , , , , |
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| Formato: | Artigo |
| Idioma: | English |
| Publicado em: |
Elsevier
2022-06-01
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| coleção: | Journal of Infection and Public Health |
| Assuntos: | |
| Acesso em linha: | http://www.sciencedirect.com/science/article/pii/S187603412200123X |
| _version_ | 1828781038351941632 |
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| author | Zainab Al Duhailib Simon Oczkowski Kamil Polok Jakub Fronczek Wojciech Szczeklik Joshua Piticaru Manoj J. Mammen Fayez Alshamsi John Eikelboom Emilie Belley-Cote Waleed Alhazzani |
| author_facet | Zainab Al Duhailib Simon Oczkowski Kamil Polok Jakub Fronczek Wojciech Szczeklik Joshua Piticaru Manoj J. Mammen Fayez Alshamsi John Eikelboom Emilie Belley-Cote Waleed Alhazzani |
| author_sort | Zainab Al Duhailib |
| collection | DOAJ |
| description | Hospitalized patients with coronavirus disease 2019 (COVID-19), particularly those admitted to the intensive care unit (ICU) are at high risk of morbidity and mortality. Several observational studies have described hemostatic derangements and thrombotic complications in patients with COVID-19. The aim of this review article is to summarize the current evidence on pathologic findings, pathophysiology, coagulation and hemostatic abnormalities, D-dimer’s role in prognostication epidemiology and risk factors of thrombotic complications, and the role of prophylactic and therapeutic anticoagulation in patients with COVID-19. While existing evidence is limited in quality, COVID-19 appears to increase micro-and macro-vascular thrombosis rates in hospitalized and critically ill patients, which may contribute to the burden of disease. D-dimer can be used for risk stratification of hospitalized patients, but its role to guide anticoagulation therapy remains unclear. Evidence of higher quality is needed to address the role of therapeutic anticoagulation or high-intensity venous thromboembolism prophylaxis in COVID-19 patients. Take-home points: • The prevalence of venous thromboembolism (VTE) in hospitalized COVID-19 patients is high, therefore, clinicians should have a high index of suspicion. • The pathophysiology of thrombosis is likely related to a combination of SARS-CoV-2 direct endothelial injury and dysregulated inflammation causing coagulation activation. • The current evidence on the value of D-dimer guided therapy is limited. • The rate of VTE post-hospital discharge is very low, supporting the safety of current discharge practice without VTE prophylaxis in most patients. • The role of higher-intensity VTE prophylaxis or therapeutic anticoagulation in critically ill COVID-19 patients without documented or suspected VTE remains uncertain. • Therapeutic anticoagulation in hospitalized non-critically ill patients with COVID-19 may improve outcomes but more research is warranted. |
| first_indexed | 2024-12-11T17:27:19Z |
| format | Article |
| id | doaj.art-6a19fe0c3e204e8991fc4857f9faa94d |
| institution | Directory Open Access Journal |
| issn | 1876-0341 |
| language | English |
| last_indexed | 2024-12-11T17:27:19Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Infection and Public Health |
| spelling | doaj.art-6a19fe0c3e204e8991fc4857f9faa94d2022-12-22T00:56:56ZengElsevierJournal of Infection and Public Health1876-03412022-06-01156689702Venous and arterial thrombosis in COVID-19: An updated narrative reviewZainab Al Duhailib0Simon Oczkowski1Kamil Polok2Jakub Fronczek3Wojciech Szczeklik4Joshua Piticaru5Manoj J. Mammen6Fayez Alshamsi7John Eikelboom8Emilie Belley-Cote9Waleed Alhazzani10Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Corresponding author at: Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, CanadaCentre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, PolandCentre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, PolandCentre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, PolandDepartment of Medicine, McMaster University, Hamilton, Ontario, CanadaDepartment of Medicine, Division of Pulmonary and Critical Care Medicine, University of Rochester, USADepartment of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab EmiratesPopulation Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, CanadaPopulation Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, CanadaDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi ArabiaHospitalized patients with coronavirus disease 2019 (COVID-19), particularly those admitted to the intensive care unit (ICU) are at high risk of morbidity and mortality. Several observational studies have described hemostatic derangements and thrombotic complications in patients with COVID-19. The aim of this review article is to summarize the current evidence on pathologic findings, pathophysiology, coagulation and hemostatic abnormalities, D-dimer’s role in prognostication epidemiology and risk factors of thrombotic complications, and the role of prophylactic and therapeutic anticoagulation in patients with COVID-19. While existing evidence is limited in quality, COVID-19 appears to increase micro-and macro-vascular thrombosis rates in hospitalized and critically ill patients, which may contribute to the burden of disease. D-dimer can be used for risk stratification of hospitalized patients, but its role to guide anticoagulation therapy remains unclear. Evidence of higher quality is needed to address the role of therapeutic anticoagulation or high-intensity venous thromboembolism prophylaxis in COVID-19 patients. Take-home points: • The prevalence of venous thromboembolism (VTE) in hospitalized COVID-19 patients is high, therefore, clinicians should have a high index of suspicion. • The pathophysiology of thrombosis is likely related to a combination of SARS-CoV-2 direct endothelial injury and dysregulated inflammation causing coagulation activation. • The current evidence on the value of D-dimer guided therapy is limited. • The rate of VTE post-hospital discharge is very low, supporting the safety of current discharge practice without VTE prophylaxis in most patients. • The role of higher-intensity VTE prophylaxis or therapeutic anticoagulation in critically ill COVID-19 patients without documented or suspected VTE remains uncertain. • Therapeutic anticoagulation in hospitalized non-critically ill patients with COVID-19 may improve outcomes but more research is warranted.http://www.sciencedirect.com/science/article/pii/S187603412200123XAnticoagulationCOVID-19ThrombosisVenous thromboembolism prophylaxisCritically illD-dimer level |
| spellingShingle | Zainab Al Duhailib Simon Oczkowski Kamil Polok Jakub Fronczek Wojciech Szczeklik Joshua Piticaru Manoj J. Mammen Fayez Alshamsi John Eikelboom Emilie Belley-Cote Waleed Alhazzani Venous and arterial thrombosis in COVID-19: An updated narrative review Journal of Infection and Public Health Anticoagulation COVID-19 Thrombosis Venous thromboembolism prophylaxis Critically ill D-dimer level |
| title | Venous and arterial thrombosis in COVID-19: An updated narrative review |
| title_full | Venous and arterial thrombosis in COVID-19: An updated narrative review |
| title_fullStr | Venous and arterial thrombosis in COVID-19: An updated narrative review |
| title_full_unstemmed | Venous and arterial thrombosis in COVID-19: An updated narrative review |
| title_short | Venous and arterial thrombosis in COVID-19: An updated narrative review |
| title_sort | venous and arterial thrombosis in covid 19 an updated narrative review |
| topic | Anticoagulation COVID-19 Thrombosis Venous thromboembolism prophylaxis Critically ill D-dimer level |
| url | http://www.sciencedirect.com/science/article/pii/S187603412200123X |
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