Abstract
COVID-19 is a global pandemic with a daily increasing number of affected individuals. Thrombosis is a severe complication of COVID-19 that leads to a worse clinical course with higher rates of mortality. Multiple lines of evidence suggest that hyperinflammation plays a crucial role in disease progression. This review compiles clinical data of COVID-19 patients who developed thrombotic complications to investigate the possible role of hyperinflammation in inducing hypercoagulation. A systematic literature search was performed using PubMed, Embase, Medline and Scopus to identify relevant clinical studies that investigated thrombotic manifestations and reported inflammatory and coagulation biomarkers in COVID-19 patients. Only 54 studies met our inclusion criteria, the majority of which demonstrated significantly elevated inflammatory markers. In the cohort studies with control, D-dimer was significantly higher in COVID-19 patients with thrombosis as compared to the control. Pulmonary embolism, deep vein thrombosis and strokes were frequently reported which could be attributed to the hyperinflammatory response associated with COVID-19 and/or to the direct viral activation of platelets and endothelial cells, two mechanisms that are discussed in this review. It is recommended that all admitted COVID-19 patients should be assessed for hypercoagulation. Furthermore, several studies have suggested that anticoagulation may be beneficial, especially in hospitalized non-ICU patients. Although vaccines against SARS-CoV-2 have been approved and distributed in several countries, research should continue in the field of prevention and treatment of COVID-19 and its severe complications including thrombosis due to the emergence of new variants against which the efficacy of the vaccines is not yet clear.
Keywords: COVID‐19; D‐dimer; SARS‐CoV‐2; pulmonary embolism; stroke; thrombosis; venous thrombosis.
【저자키워드】 thrombosis, stroke, COVID‐19, SARS‐CoV‐2, Pulmonary embolism, Venous thrombosis., D‐dimer, 【초록키워드】 COVID-19, Treatment, SARS-CoV-2, Efficacy, Vaccine, Biomarker, Hospitalized, Mortality, anticoagulation, thrombosis, Thrombotic complications, variant, inflammatory markers, D-dimer, Platelets, Cohort studies, cohort study, Coagulation, global pandemic, Disease progression, Clinical course, endothelial cells, Pulmonary embolism, hyperinflammation, Research, Venous thrombosis, Clinical studies, mechanism, COVID-19 patients, Deep vein thrombosis, Hypercoagulation, Hyperinflammatory response, clinical study, Evidence, Inflammatory, D‐dimer, COVID-19 patient, manifestation, Deep vein, Clinical data, inclusion criteria, non-ICU, thrombotic, systematic literature search, non-ICU patients, Multiple, complication of COVID-19, Hyperinflammatory, thrombotic complication, identify, affected, significantly, reported, investigated, approved, elevated, was performed, majority, demonstrated, suggested, significantly higher, individuals, the vaccine, severe complication, activation of platelet, with COVID-19, 【제목키워드】 Inflammation, systematic review, COVID-19 patient, systemic, venous, induce,