Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Apr;35(2):215-229.
doi: 10.1007/s10557-020-07084-9. Epub 2020 Oct 19.

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

Aleksandra Gąsecka #  1 , Josip A Borovac #  2 , Rui Azevedo Guerreiro  3 , Michela Giustozzi  4 , William Parker  5 , Daniel Caldeira  6   7 , Gemma Chiva-Blanch  8   9
Affiliations
Review

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

Aleksandra Gąsecka et al. Cardiovasc Drugs Ther. 2021 Apr.

Abstract

Introduction: Emerging evidence points to an association between severe clinical presentation of COVID-19 and increased risk of thromboembolism. One-third of patients hospitalized due to severe COVID-19 develops macrovascular thrombotic complications, including venous thromboembolism, myocardial injury/infarction and stroke. Concurrently, the autopsy series indicate multiorgan damage pattern consistent with microvascular injury.

Prophylaxis, diagnosis and treatment: COVID-19 associated coagulopathy has distinct features, including markedly elevated D-dimers concentration with nearly normal activated partial thromboplastin time, prothrombin time and platelet count. The diagnosis may be challenging due to overlapping features between pulmonary embolism and severe COVID-19 disease, such as dyspnoea, high concentration of D-dimers, right ventricle with dysfunction or enlargement, and acute respiratory distress syndrome. Both macro- and microvascular complications are associated with an increased risk of in-hospital mortality. Therefore, early recognition of coagulation abnormalities among hospitalized COVID-19 patients are critical measures to identify patients with poor prognosis, guide antithrombotic prophylaxis or treatment, and improve patients' clinical outcomes.

Recommendations for clinicians: Most of the guidelines and consensus documents published on behalf of professional societies focused on thrombosis and hemostasis advocate the use of anticoagulants in all patients hospitalized with COVID-19, as well as 2-6 weeks post hospital discharge in the absence of contraindications. However, since there is no guidance for deciding the intensity and duration of anticoagulation, the decision-making process should be made in individual-case basis.

Conclusions: Here, we review the mechanistic relationships between inflammation and thrombosis, discuss the macrovascular and microvascular complications and summarize the prophylaxis, diagnosis and treatment of thromboembolism in patients affected by COVID-19.

Keywords: COVID-19; Inflammation; Prophylaxis; SARS-CoV-2; Thrombosis; Venous thromboembolism.

PubMed Disclaimer

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
The pathophysiological mechanisms underlying COVID-19-associated coagulopathy. These mechanisms seem to follow Virchow’s triad, including (i) diffuse endothelial cell injury, (ii) abnormal blood flow dynamics, and (iii) uncontrolled platelet activation [71]
See this image and copyright information in PMC

References

    1. Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, Si HR, Zhu Y, Li B, Huang CL, Chen HD, Chen J, Luo Y, Guo H, Jiang RD, Liu MQ, Chen Y, Shen XR, Wang X, Zheng XS, Zhao K, Chen QJ, Deng F, Liu LL, Yan B, Zhan FX, Wang YY, Xiao GF, Shi ZL. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270–273. doi: 10.1038/s41586-020-2012-7. - DOI - PMC - PubMed
    1. World Health O . Coronavirus disease 2019 (COVID-19): situation report, 157. Geneva: World Health Organization; 2020.
    1. Gómez-Carballa A, Bello X, Pardo-Seco J, Martinón-Torres F, Salas A (2020) The impact of super-spreaders in COVID-19: mapping genome variation worldwide. bioRxiv:2020.2005.2019.097410. doi:10.1101/2020.05.19.097410 - PMC - PubMed
    1. Mori J, Oudit GY, Lopaschuk GD. SARS-CoV-2 perturbs the Renin-Angiotensin System and energy metabolism. Am J Physiol Endocrinol Metab. 2020;319:E43–E47. doi: 10.1152/ajpendo.00219.2020. - DOI - PMC - PubMed
    1. Gheblawi M, Wang K, Viveiros A, Nguyen Q, Zhong JC, Turner AJ, Raizada MK, Grant MB, Oudit GY. Angiotensin-Converting Enzyme 2: SARS-CoV-2 Receptor and Regulator of the Renin-Angiotensin System: Celebrating the 20th Anniversary of the Discovery of ACE2. Circ Res. 2020;126(10):1456–1474. doi: 10.1161/CIRCRESAHA.120.317015. - DOI - PMC - PubMed