Thromboembolic complications of COVID-19: the combined effect of a pro-coagulant pattern and an endothelial thrombo-inflammatory syndrome

Clin Radiol. 2020 Nov;75(11):804-810. doi: 10.1016/j.crad.2020.07.019. Epub 2020 Aug 4.

Abstract

Coronavirus disease 2019 (COVID-19) is a newly emerging human infectious disease that has quickly become a worldwide threat to health, mainly causing severe acute respiratory syndrome. In addition to the widely described respiratory syndrome, COVID-19 may cause life-treating complications directly or indirectly related to this infection. Among these, thrombotic complications have emerged as an important issue in patients with COVID-19 infection, particularly in patients in intensive care units. Thrombotic complications due to COVID-19 are likely to occur due to a pro-coagulant pattern encountered in some of these patients or to a progressive endothelial thrombo-inflammatory syndrome causing microvascular disease. In the present authors' experience, from five different hospitals in Italy and the UK, imaging has proved its utility in identifying these COVID-19-related thrombotic complications, with translational clinical relevance. The aim of this review is to illustrate thromboembolic complications directly or indirectly related to COVID-19 disease. Specifically, this review will show complications related to thromboembolism due to a pro-coagulant pattern from those likely related to an endothelial thrombo-inflammatory syndrome.

Publication types

  • Review

MeSH terms

  • Adult
  • Aged
  • Anticoagulants / administration & dosage*
  • Brain Ischemia / diagnostic imaging
  • Brain Ischemia / etiology
  • Brain Ischemia / mortality
  • COVID-19
  • Cause of Death
  • Communicable Diseases, Emerging / epidemiology
  • Coronavirus Infections / complications*
  • Coronavirus Infections / mortality
  • Coronavirus Infections / physiopathology
  • Female
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / mortality
  • Pneumonia, Viral / physiopathology
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / drug therapy
  • Pulmonary Embolism / etiology*
  • Pulmonary Embolism / mortality
  • Radiography, Thoracic / methods
  • Severe Acute Respiratory Syndrome / complications*
  • Severe Acute Respiratory Syndrome / diagnosis
  • Severe Acute Respiratory Syndrome / mortality
  • Survival Analysis
  • Thromboembolism / diagnostic imaging
  • Thromboembolism / drug therapy*
  • Thromboembolism / etiology*
  • Thromboembolism / mortality
  • Thromboplastin / metabolism
  • Tomography, X-Ray Computed / methods

Substances

  • Anticoagulants
  • Thromboplastin