Role of Acute Thrombosis in COVID-19

Patients with SARS-CoV-2 are prone to venous, cerebrovascular and coronary thrombi, particularly those with severe COVID-19. The pathogenesis is multifactorial and likely involves proinflammatory cascades, development of coagulopathy and neutrophil extracellular traps (NETs), although further investigations are needed. Elevated D-dimers are common in patients with COVID-19 and cannot be used in isolation to predict VTE in people with SARS-CoV-2. If given early in hospital admission, therapeutic dose heparin improves clinical outcomes in patients with moderate COVID-19. To date, anti-thrombotics have not improved outcomes in patients with severe COVID-19, possibly because significant tissue damage has already occurred. There is insufficient evidence for routine radiographic evaluation for VTEs in all patients with COVID-19, however, imaging should be considered in the evaluation of patients with sudden clinical deteriorations. Finally, prompt recognition of extra-pulmonary thrombi —particularly in the brain or heart—may be beneficial, but additional evidence is needed and interventional response times may be limited by local resources.
Source: Critical Care Clinics - Category: Intensive Care Authors: Source Type: research