Venous and arterial thrombosis in COVID-19: An updated narrative review

Zainab Al Duhailib; Simon Oczkowski; Kamil Polok; Jakub Fronczek; Wojciech Szczeklik; Joshua Piticaru; Manoj J Mammen; Fayez Alshamsi; John Eikelboom; Emilie Belley-Cote; Waleed Alhazzani

doi:10.1016/j.jiph.2022.05.003

Venous and arterial thrombosis in COVID-19: An updated narrative review

J Infect Public Health. 2022 Jun;15(6):689-702. doi: 10.1016/j.jiph.2022.05.003. Epub 2022 May 14.

Authors

Affiliations

¹ Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. Electronic address: zalduhailib65@kfshrc.edu.sa.
² Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
³ Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
⁴ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁵ Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Rochester, USA.
⁶ Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
⁷ Population Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁸ Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Abstract

Hospitalized patients with coronavirus disease 2019 (COVID-19), particularly those admitted to the intensive care unit (ICU) are at high risk of morbidity and mortality. Several observational studies have described hemostatic derangements and thrombotic complications in patients with COVID-19. The aim of this review article is to summarize the current evidence on pathologic findings, pathophysiology, coagulation and hemostatic abnormalities, D-dimer's role in prognostication epidemiology and risk factors of thrombotic complications, and the role of prophylactic and therapeutic anticoagulation in patients with COVID-19. While existing evidence is limited in quality, COVID-19 appears to increase micro-and macro-vascular thrombosis rates in hospitalized and critically ill patients, which may contribute to the burden of disease. D-dimer can be used for risk stratification of hospitalized patients, but its role to guide anticoagulation therapy remains unclear. Evidence of higher quality is needed to address the role of therapeutic anticoagulation or high-intensity venous thromboembolism prophylaxis in COVID-19 patients. TAKE-HOME POINTS.

Keywords: Anticoagulation; COVID-19; Critically ill; D-dimer level; Thrombosis; Venous thromboembolism prophylaxis.

Publication types

Review

MeSH terms

Anticoagulants / therapeutic use
COVID-19* / complications
Hemostatics*
Humans
SARS-CoV-2
Thrombosis* / drug therapy
Thrombosis* / epidemiology
Thrombosis* / etiology

Substances

Anticoagulants
Hemostatics