Long COVID: pathophysiological factors and abnormalities of coagulation

Simone Turner; M Asad Khan; David Putrino; Ashley Woodcock; Douglas B Kell; Etheresia Pretorius

doi:10.1016/j.tem.2023.03.002

Long COVID: pathophysiological factors and abnormalities of coagulation

Trends Endocrinol Metab. 2023 Jun;34(6):321-344. doi: 10.1016/j.tem.2023.03.002. Epub 2023 Apr 19.

Authors

Simone Turner¹, M Asad Khan², David Putrino³, Ashley Woodcock⁴, Douglas B Kell⁵, Etheresia Pretorius⁶

Affiliations

¹ Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland, 7602, South Africa.
² North West Lung Centre, Manchester University Hospitals, Manchester, M23 9LT, UK.
³ Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
⁴ The University of Manchester, Oxford Road, Manchester, M13 9PL, UK; Manchester Academic Health Science Centre, CityLabs, Manchester, M13 9NQ, UK.
⁵ Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland, 7602, South Africa; Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool, L69 7ZB, UK; The Novo Nordisk Foundation Centre for Biosustainability, Building 220, Kemitorvet, Technical University of Denmark, 2800 Kongens Lyngby, Denmark. Electronic address: dbk@liv.ac.uk.
⁶ Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland, 7602, South Africa; Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool, L69 7ZB, UK. Electronic address: resiap@sun.ac.za.

Abstract

Acute COVID-19 infection is followed by prolonged symptoms in approximately one in ten cases: known as Long COVID. The disease affects ~65 million individuals worldwide. Many pathophysiological processes appear to underlie Long COVID, including viral factors (persistence, reactivation, and bacteriophagic action of SARS CoV-2); host factors (chronic inflammation, metabolic and endocrine dysregulation, immune dysregulation, and autoimmunity); and downstream impacts (tissue damage from the initial infection, tissue hypoxia, host dysbiosis, and autonomic nervous system dysfunction). These mechanisms culminate in the long-term persistence of the disorder characterized by a thrombotic endothelialitis, endothelial inflammation, hyperactivated platelets, and fibrinaloid microclots. These abnormalities of blood vessels and coagulation affect every organ system and represent a unifying pathway for the various symptoms of Long COVID.

Keywords: cardiovascular outcomes; clotting pathology; endothelialitis; long COVID.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19*
Humans
Inflammation
Post-Acute COVID-19 Syndrome
SARS-CoV-2
Thrombosis*