Clinical features of thrombosis and bleeding in COVID-19.
Marie Anne ScullyMarie ScullyPublished in: Blood (2022)
Infection with the SARS-CoV-2 virus, resulting in COVID-19 disease, has presented a unique scenario associated with high rates of thrombosis. The risk of venous thrombosis is some three- to sixfold higher than for patients admitted to a hospital for other indications, and for patients who have thrombosis, mortality appears to increase. Thrombosis may be a presenting feature of COVID-19. Pulmonary thrombi are the most frequent events, some related to deep vein thrombosis, but also to in situ microvascular and macrovascular thrombosis. Other venous thromboses include catheter- and circuit-associated in patients requiring hemofiltration and extracorporeal membrane oxygenation. Arterial thrombosis is less commonly documented, with 3% of patients in intensive care units having major arterial strokes and up to 9% having myocardial infarction, both of which are most likely multifactorial. Risk factors for thrombosis above those already documented in hospital settings include duration of COVID-19 symptoms before admission to the hospital. Laboratory parameters associated with higher risk of thrombosis include higher D-dimer, low fibrinogen, and low lymphocyte count, with higher factor VIII and von Willebrand factor levels indicative of more severe COVID-19 infection. All patients should receive thromboprophylaxis when admitted with COVID-19 infection, but the dose and length of treatment are still debated. Thrombosis continues to be treated according to standard VTE guidelines, but adjustments may be needed depending on other factors relevant to the patient's admission.
Keyphrases
- sars cov
- pulmonary embolism
- end stage renal disease
- ejection fraction
- newly diagnosed
- chronic kidney disease
- coronavirus disease
- extracorporeal membrane oxygenation
- prognostic factors
- heart failure
- type diabetes
- acute respiratory distress syndrome
- emergency department
- left ventricular
- risk factors
- pulmonary hypertension
- cardiovascular disease
- machine learning
- atrial fibrillation
- patient reported outcomes
- physical activity
- case report
- depressive symptoms
- replacement therapy