Systemic inflammation in COVID‐19 patients may induce various types of venous and arterial thrombosis: A systematic review. (27th September 2021)

• Record Type: Journal Article
• Authors: Tomerak, Sara; Khan, Safah; Almasri, Muna; Hussein, Rawan; Abdelati, Ali; Aly, Ahmed; Salameh, Mohammad A.; Saed Aldien, Arwa; Naveed, Hiba; Elshazly, Mohamed B.; Zakaria, Dalia
• Is Part Of: Scandinavian journal of immunology. Volume 94:Number 5(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-09-27
• Subjects: COVID‐19 -- D‐dimer -- pulmonary embolism -- SARS‐CoV‐2 -- stroke -- thrombosis -- venous thrombosis; Immunology -- Periodicals; 571.96
• DOI: 10.1111/sji.13097
• Languages: English
• ISSNs: 0300-9475

Abstract

Abstract: COVID‐19 is a global pandemic with a daily increasing number of affected individuals. Thrombosis is a severe complication of COVID‐19 that leads to a worse clinical course with higher rates of mortality. Multiple lines of evidence suggest that hyperinflammation plays a crucial role in disease progression. This review compiles clinical data of COVID‐19 patients who developed thrombotic complications to investigate the possible role of hyperinflammation in inducing hypercoagulation. A systematic literature search was performed using PubMed, Embase, Medline and Scopus to identify relevant clinical studies that investigated thrombotic manifestations and reported inflammatory and coagulation biomarkers in COVID‐19 patients. Only 54 studies met our inclusion criteria, the majority of which demonstrated significantly elevated inflammatory markers. In the cohort studies with control, D‐dimer was significantly higher in COVID‐19 patients with thrombosis as compared to the control. Pulmonary embolism, deep vein thrombosis and strokes were frequently reported which could be attributed to the hyperinflammatory response associated with COVID‐19 and/or to the direct viral activation of platelets and endothelial cells, two mechanisms that are discussed in this review. It is recommended that all admitted COVID‐19 patients should be assessed for hypercoagulation. Furthermore, several studies have suggested that anticoagulation may be beneficial, especially in hospitalized non‐ICU patients. Although vaccines against SARS‐CoV‐2 have been approved and distributed in several countries, research should continue in the field of prevention and treatment of COVID‐19 and its severe complications including thrombosis due to the emergence of new variants against which the efficacy of the vaccines is not yet clear.