COVID-19 coagulopathy, thrombosis, and bleeding - PubMed (original) (raw)

Comment

COVID-19 coagulopathy, thrombosis, and bleeding

Noel C Chan et al. Blood. 2020.

Abstract

In this issue of Blood, Al-Samkari et al expand our understanding of thrombosis and bleeding risks and their predictors in hospitalized patients with coronavirus disease 2019 (COVID-19).

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

Potential mechanism linking dysregulated inflammation and coagulation with thrombosis. SARS-CoV-2 infects respiratory epithelial cells by binding to the angiotensin-converting enzyme 2 (ACE-2) receptor. Shed virus elicits an inflammatory response, which can be maladaptive in some cases leading to a cytokine storm mediated by proinflammatory cytokines such as interleukin 1β (IL-1β), IL-2, IL-6, tumor necrosis factor (TNF), and granulocyte-macrophage colony-stimulating factor (GM-CSF). Proinflammatory cytokines and SARS-CoV-2 infection of the endothelium contribute to hypercoagulability by upregulation of procoagulants such as tissue factor (TF), P-selectin, factor VIII (FVIII), fibrinogen, and von Willebrand factor (vWF); downregulation of anticoagulants such as thrombomodulin (TM) and endothelial protein C receptor (EPCR); and modulation of fibrinolysis by increased expression of type 1 plasminogen activator inhibitor, and leukocyte recruitment. Finally, the hypoxia and immobility in hospitalized patients with COVID-19 are potent triggers of thrombosis. Illustration created with

BioRender.com

.

Comment on

• COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection.
  Al-Samkari H, Karp Leaf RS, Dzik WH, Carlson JCT, Fogerty AE, Waheed A, Goodarzi K, Bendapudi PK, Bornikova L, Gupta S, Leaf DE, Kuter DJ, Rosovsky RP. Al-Samkari H, et al. Blood. 2020 Jul 23;136(4):489-500. doi: 10.1182/blood.2020006520. Blood. 2020. PMID: 32492712 Free PMC article. Clinical Trial.

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References

1. 1. Al-Samkari H, Karp Leaf RS, Dzik WH, et al. . COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood. 2020;136(4):489-500. - PMC - PubMed
2. 1. Middeldorp S, Coppens M, van Haaps TF, et al. . Incidence of venous thromboembolism in hospitalized patients with COVID-19 [published online ahead of print 5 May 2020]. J Thromb Haemost. doi:10.1111/jth.14888. - PMC - PubMed
3. 1. Nahum J, Morichau-Beauchant T, Daviaud F, et al. . Venous thrombosis among critically ill patients with coronavirus disease 2019 (COVID-19) [letter]. JAMA Netw Open. 2020;3(5):e2010478. - PMC - PubMed
4. 1. Lodigiani C, Iapichino G, Carenzo L, et al. ; Humanitas COVID-19 Task Force . Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020;191:9-14. - PMC - PubMed
5. 1. Deshpande C. Thromboembolic findings in COVID-19 autopsies: pulmonary thrombosis or embolism? [editorial] [published online ahead of print 15 May 2020]. Ann Intern Med. doi:10.7326/M20-3255. - PMC - PubMed

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