Therapeutic considerations for prevention and treatment of thrombotic events in COVID-19

Faria Khimani; Adam J Wolf; Braian Yoon; Amy Blancke; Coltin Gerhart; Dakota Endsley; Alleyna Dougherty; Anish K Ray; Angelito F Yango; Stuart D Flynn; Gregory Y H Lip; Stevan A Gonzalez; Mohanakrishnan Sathyamoorthy

doi:10.1016/j.tru.2022.100126

Therapeutic considerations for prevention and treatment of thrombotic events in COVID-19

Thromb Update. 2023 Mar:10:100126. doi: 10.1016/j.tru.2022.100126. Epub 2022 Nov 11.

Authors

Faria Khimani^{1

2}, Adam J Wolf^{1

2}, Braian Yoon^{1

2}, Amy Blancke³, Coltin Gerhart^{1

2}, Dakota Endsley^{1

2}, Alleyna Dougherty^{1

2}, Anish K Ray⁴, Angelito F Yango^{5

6}, Stuart D Flynn², Gregory Y H Lip⁷, Stevan A Gonzalez^{5

6}, Mohanakrishnan Sathyamoorthy^{1

5

3}

Affiliations

¹ Sathyamoorthy Laboratory, Burnett School of Medicine at TCU, Fort Worth, TX, United States.
² Burnett School of Medicine at TCU, Fort Worth, TX, United States.
³ Consultants in Cardiovascular Medicine and Science - Fort Worth, PLLC, Fort Worth, TX, United States.
⁴ Department of Pediatrics, Burnett School of Medicine at TCU, Fort Worth, TX, United States and Cook Children's Medical Center, Fort Worth, TX, United States.
⁵ Department of Medicine, Burnett School of Medicine at TCU, Fort Worth, TX, United States.
⁶ Annette C. and Harold C. Simmons Transplant Institute, Baylor All Saints Medical Center, Fort Worth, TX, United States.
⁷ Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom, and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Abstract

Thrombosis is a known complication of SARS-CoV-2 infection, particularly within a severely symptomatic subset of patients with COVID-19 disease, in whom an aggressive host immune response leads to cytokine storm syndrome (CSS). The incidence of thrombotic events coinciding with CSS may contribute to the severe morbidity and mortality observed in association with COVID-19. This review provides an overview of pharmacologic approaches based upon an emerging understanding of the mechanisms responsible for thrombosis across a spectrum of COVID-19 disease involving an interplay between immunologic and pro-thrombotic events, including endothelial injury, platelet activation, altered coagulation pathways, and impaired fibrinolysis.

Keywords: Anti-thrombotics in COVID-19; Anticoagulation in COVID-19; COVID-19; Coagulopathy; Deep vein thrombosis in COVID-19; Pulmonary embolism in COVID-19; Thrombosis.

Publication types

Review