COVID-19 and Sickle Cell Disease: Two Independent Risk Factors for Venous Thromboembolism

Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been widely documented as a multi-systemic illness and associated with an increased incidence of thromboses. Likewise, sickle cell disease (SCD) is a hematologic disease responsible for widespread effects on the vasculature and is also associated with elevated thrombotic risk. In this review, we examine the incidence rates of venous thromboembolism (VTE) in SCD and COVID-19 independently and review the mechanisms of coagulopathy associated with both diseases. We describe the possible associations and commonalities between VTE mechanisms, as both diseases cause widespread inflammation that influences each tenet of Virchow's triad. We also discuss current anticoagulation guideline recommendations for the prevention of VTE events in each of these diseases. We report on current literature to date describing rates of VTE in SCD-COVID-19 patients and outline prospective areas of research to further understand the possible synergistic influence of coagulopathy in these patients. The association between SCD and COVID-19 remains a largely under-researched area of coagulopathy in current hematology and thrombotic literature, and our report lays out potential future prospects in the field.

Keywords: covid coagulopathy; covid-19; sickle cell complications; sickle cell disease: scd; venous thromboembolsim; virchow’s triad.

Figure 1. Mechanisms by which SCD and COVID-19 influence each factor of Virchow's triad

ACE2: angiotensin-converting enzyme 2; COVID-19: coronavirus disease 2019; PF4: platelet factor 4; SCD: sickle cell disease; TF: tissue factor; vWF: von Willebrand factor