Caging the dragon: Research approach to COVID-19-related thrombosis

Abstract

The incidence of venous thrombosis, mostly pulmonary embolism (PE), ranging from local immunothrombosis to central emboli, but also deep vein thrombosis (DVT) in people with coronavirus disease 2019 (COVID-19) is reported to be remarkably high. The relevance of better understanding, predicting, treating, and preventing COVID-19-associated venous thrombosis meets broad support, as can be concluded from the high number of research, review, and guideline papers that have been published on this topic. The Dutch COVID & Thrombosis Coalition (DCTC) is a multidisciplinary team involving a large number of Dutch experts in the broad area of venous thrombosis and hemostasis research, combined with experts on virology, critically ill patients, pulmonary diseases, and community medicine, across all university hospitals and many community hospitals in the Netherlands. Within the consortium, clinical data of at least 5000 admitted COVID-19-infected individuals are available, including substantial collections of biobanked materials in an estimated 3000 people. In addition to considerable experience in preclinical and clinical thrombosis research, the consortium embeds virology-hemostasis research models within unique biosafety facilities to address fundamental questions on the interaction of virus with epithelial and vascular cells, in relation to the coagulation and inflammatory system. The DCTC has initiated a comprehensive research program to answer many of the current questions on the pathophysiology and best anticoagulant treatment of COVID-19-associated thrombotic complications. The research program was funded by grants of the Netherlands Thrombosis Foundation and the Netherlands Organization for Health Research and Development. Here, we summarize the design and main aims of the research program.

Keywords: COVID‐19; anticoagulants; pulmonary embolism; severe acute respiratory syndrome coronavirus 2; thrombosis; venous thrombosis.

FIGURE 1

Integration of the five work packages

FIGURE 2

Dedicated patient pathway applied to survivors of COVID‐19–associated VTE according to the Dutch Guideline of care for patients with COVID‐19–associated venous thromboembolism. ^#CPET is indicated if echocardiography does not show signs of pulmonary hypertension. ^†VQ scan, pulmonary function tests, CPET, echocardiography depending in individual patient characteristics. In case of Chronic Thromboembolic Pulmonary Disease (CTEPD), patients should be referred to a CTEPH expertise center. CTEPH, chronic thromboembolic pulmonary hypertension; CTEPD, chronic thromboembolic pulmonary disease; VQ scan, ventilation perfusion scintigraphy; PTS, postthrombotic syndrome; CPET, cardiopulmonary exercise test