Thrombosis in Covid-19 Patients and Dilemma of Antithrombotic Choice: A Systematic Review

Nso Nso; Mahmoud Nassar; Gilbert Ojong; Akwe Nyabera; Sofia Lakhdar; Mohsen Alshamam; Somtochukwu Nwokoye; Matthew Li; Mostafa Alfishawy; Debra J. Brennessel

American Journal of Educational Research. 2021, 9(3), 117-124
DOI: 10.12691/education-9-3-5

Open AccessReview Article

Thrombosis in Covid-19 Patients and Dilemma of Antithrombotic Choice: A Systematic Review

Nso Nso^1,, Mahmoud Nassar¹, Gilbert Ojong², Akwe Nyabera¹, Sofia Lakhdar¹, Mohsen Alshamam¹, Somtochukwu Nwokoye³, Matthew Li¹, Mostafa Alfishawy⁴ and Debra J. Brennessel¹

¹Internal Medicine, Icahn School of Medicine, Mount Sinai/NYC Health Hospital, Queens, New York.

²Department of Internal Medicine, La Magna Health/United Regional Hospital

³Augusta University-University of Georgia Medical Partnership, St. Mary's Hospital

⁴3Augusta University-University of Georgia Medical Partnership, St. Mary's Hospital

Pub. Date: March 25, 2021

View Full Text Full Text PDF Full Text ePUB

Cite this paper:
Nso Nso, Mahmoud Nassar, Gilbert Ojong, Akwe Nyabera, Sofia Lakhdar, Mohsen Alshamam, Somtochukwu Nwokoye, Matthew Li, Mostafa Alfishawy and Debra J. Brennessel. Thrombosis in Covid-19 Patients and Dilemma of Antithrombotic Choice: A Systematic Review. American Journal of Educational Research. 2021; 9(3):117-124. doi: 10.12691/education-9-3-5

Abstract

Background: Coronavirus Disease 2019 (COVID-19) potentially deteriorates the immune system and triggers prothrombotic states in many patient scenarios. Clinical studies so far do not stratify the risk of thromboembolism in COVID-19 cases. Objective: This systematic review investigates the risks of thromboembolism and outcomes of anticoagulation therapy in COVID-19 patients. Methods: We searched PubMed, Cochrane Library, Embase, Web of Science, and Google Scholar to identify relevant studies assessing thromboembolism and anticoagulant therapy in COVID-19 patients. Study Selection, Data Extraction, and Synthesis: Two reviewers screened the titles and abstracts of the included studies in the context of COVID-19, thrombosis, and anticoagulant therapy. The reviewers also ascertained the elimination of duplicate articles. Results: We included eight studies based on the thromboembolism predisposition of COVID-19 (adult/elderly) patients with the status/history of cardiovascular disease, diabetes, hypertension, obesity, and hospital admission. Conclusion: Prospective studies need to explore the risks of thromboembolism in patients with COVID-19. The current body of evidence does not substantiate antithrombotic treatment for managing thromboembolism in the setting of COVID-19. The physicians must take preventive measures for reducing the incidence rate of thromboembolism in COVID-19 scenarios until the availability of definitive treatment.

Keywords:
thromboses COVID-19 anticoagulants incidence SARS-CoV-2

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	WHO. Coronavirus (COVID-19) events as they happen [Internet]. WHO. 2020 [cited 2021 4th January]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen.

[2]	Blagosklonny M V. From causes of aging to death from COVID-19. Aging (Albany NY) [Internet]. 2020 Jun 15 [cited 2021 Jan 4]; 12(11): 10004-21.

[3]	Cho SJ, Stout-Delgado HW. Aging and Lung Disease. Annu Rev Physiol [Internet]. 2020 Feb 10 [cited 2021 Jan 4]; 82(1): 433-59.

[4]	Gerstorf D, Hülür G, Drewelies J, Willis SL, Schaie KW, Ram N. Adult development and aging in historical context. Am Psychol [Internet]. 2020 May 1 [cited 2021 Jan 4]; 75(4): 525-39.

[5]	Ferrucci L, Gonzalez-Freire M, Fabbri E, Simonsick E, Tanaka T, Moore Z, et al. Measuring biological aging in humans: A quest [Internet]. Vol. 19, Aging Cell. Blackwell Publishing Ltd; 2020 [cited 2021 4th January].

[6]	Chen Y, Klein SL, Garibaldi BT, Li H, Wu C, Osevala NM, et al. Aging in COVID-19: Vulnerability, immunity and intervention. Vol. 65, Ageing Research Reviews. Elsevier Ireland Ltd; 2021. p. 101205.

[7]	Whatley MC, Siegel ALM, Schwartz ST, Silaj KM, Castel AD. Younger and Older Adults' Mood and Expectations Regarding Aging During COVID-19. Gerontol Geriatr Med [Internet]. 2020 16th January [cited 2021 4th January]; 6: 233372142096025.

[8]	Clinicbarcelona.org. thrombosis are one of the main complications associated with COVID-19 \| Hospital Clínic Barcelona [Internet]. Clinicbarcelona.org. 2020 [cited 2021 4th January]. Available from: https://www.clinicbarcelona.org/en/news/thrombosis-are-one-of-the-main-complications-associated-with-covid-19.

[9]	Paolisso P, Bergamaschi L, D'Angelo EC, Donati F, Giannella M, Tedeschi S, et al. Preliminary Experience With Low Molecular Weight Heparin Strategy in COVID-19 Patients. Front Pharmacol [Internet]. 2020 Aug 6 [cited 2021 Jan 4]; 11: 1124.

[10]	Miesbach W, Makris M. COVID-19: Coagulopathy, Risk of Thrombosis, and the Rationale for Anticoagulation [Internet]. Vol. 26, Clinical and Applied Thrombosis/Hemostasis. SAGE Publications Inc.; 2020 [cited 2021 4th January]. p. 107602962093814.

[11]	Zhang C, Shen L, Le K-J, Pan M-M, Kong L-C, Gu Z-C, et al. Incidence of Venous Thromboembolism in Hospitalized Coronavirus Disease 2019 Patients: A Systematic Review and Meta-Analysis. Front Cardiovasc Med [Internet]. 2020 Aug 6 [cited 2021 Jan 4]; 7: 151.

[12]	Rotzinger DC, Beigelman-Aubry C, von Garnier C, Qanadli SD. Pulmonary embolism in patients with COVID-19: Time to change the paradigm of computed tomography. Vol. 190, Thrombosis Research. Elsevier Ltd; 2020. p. 58-9.

[13]	Wichmann D, Sperhake JP, Lütgehetmann M, Steurer S, Edler C, Heinemann A, et al. Autopsy Findings and Venous Thromboembolism in Patients With COVID-19: A Prospective Cohort Study. Ann Intern Med [Internet]. 2020 Aug 18 [cited 2021 Jan 4]; 173(4): 268-77.

[14]	Grandmaison G, Andrey A, Périard D, Engelberger RP, Carrel G, Doll S, et al. Systematic Screening for Venous Thromboembolic Events in COVID-19 Pneumonia. TH Open [Internet]. 2020 Apr [cited 2021 Jan 4]; 04(02): e113-5.

[15]	WHO. WHO Coronavirus Disease (COVID-19) Dashboard \| WHO Coronavirus Disease (COVID-19) Dashboard [Internet]. WHO. 2021 [cited 2021 Jan 22].

[16]	Tan CW, Low JGH, Wong WH, Chua YY, Goh SL, Ng HJ. Critically ill COVID-19 infected patients exhibit increased clot waveform analysis parameters consistent with hypercoagulability [Internet]. Vol. 95, American Journal of Hematology. Wiley-Liss Inc.; 2020 [cited 2021 4th January]. p. E156-8.

[17]	Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020 Jul 1; 191: 9-14.

[18]	Patell R, Bogue T, Bindal P, Koshy A, Merrill M, Aird WC, et al. incidence of thrombosis and hemorrhage in hospitalized cancer patients with COVID‐19. J Thromb Haemost [Internet]. 2020 Sep 23 [cited 2021 Jan 4]; 18(9): 2349-57.

[19]	Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, et al. incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020 1st July; 191: 145-7.

[20]	Middeldorp S, Coppens M, van Haaps TF, Foppen M, Vlaar AP, Müller MCA, et al. incidence of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost [Internet]. 2020 1st August [cited 2021 5th January];18(8): 1995-2002.

[21]	Hewitt J, Carter B, Vilches-Moraga A, Quinn TJ, Braude P, Verduri A, et al. The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study. Lancet Public Heal. 2020 Aug 1;5(8):e444-51.

[22]	Zerwes S, Hernandez Cancino F, Liebetrau D, Gosslau Y, Warm T, Märkl B, et al. Increased risk of deep vein thrombosis in intensive care unit patients with CoViD-19 infections?—Preliminary data. Chirurg [Internet]. 2020 1st July [cited 2021 5th January]; 91(7): 588-94.

[23]	Ranucci M, Ballotta A, Di Dedda U, Bayshnikova E, Dei Poli M, Resta M, et al. The procoagulant pattern of patients with COVID-19 acute respiratory distress syndrome. J Thromb Haemost [Internet]. 2020 1st July [cited 2021 5th January]; 18(7): 1747-51.

[24]	Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, et al. Comorbidity and its Impact on Patients with COVID-19. SN Compr Clin Med [Internet]. 2020 Aug 25 [cited 2021 Jan 5]; 2(8): 1069-76.

[25]	Maldonado E, Tao D, Mackey K. Antithrombotic Therapies in COVID-19 Disease: a Systematic Review [Internet]. Vol. 35, Journal of General Internal Medicine. Springer; 2020 [cited 2021 Jan 5]. p. 2698-706.

[26]	Vivas D, Roldán V, Esteve-Pastor MA, Roldán I, Tello-Montoliu A, Ruiz-Nodar JM, et al. Recommendations on antithrombotic treatment during the COVID-19 pandemic. Position statement of the Working Group on Cardiovascular Thrombosis of the Spanish Society of Cardiology. Rev Española Cardiol (English Ed. 2020 Sep 1;73(9):749-57.

[27]	Godino C, Scotti A, Maugeri N, Mancini N, Fominskiy E, Margonato A, et al. Antithrombotic therapy in patients with COVID-19? -Rationale and Evidence-. Int J Cardiol. 2020 28th September.

[28]	Wang J, Hajizadeh N, Moore EE, McIntyre RC, Moore PK, Veress LA, et al. Tissue plasminogen activator (tPA) treatment for COVID-19 associated acute respiratory distress syndrome (ARDS): A case series. J Thromb Haemost [Internet]. 2020 1st July [cited 2021 5th January]; 18(7): 1752-5.

[29]	Whyte CS, Morrow GB, Mitchell JL, Chowdary P, Mutch NJ. Fibrinolytic abnormalities in acute respiratory distress syndrome (ARDS) and versatility of thrombolytic drugs to treat COVID-19. J Thromb Haemost [Internet]. 2020 3rd July [cited 2021 5th January]; 18(7): 1548-55.

[30]	Contou D, Pajot O, Cally R, Logre E, Fraissé M, Mentec H, et al. Pulmonary embolism or thrombosis in ARDS COVID-19 patients: A French monocenter retrospective study. Garcia de Frutos P, editor. PLoS One [Internet]. 2020 Aug 27 [cited 2021 Jan 5]; 15(8): e0238413.

[31]	Paar V, Wernly B, Zhou Z, Motloch LJ, Hoppe UC, Egle A, et al. Anticoagulation for COVID-19 treatment: both antithrombotic and anti-inflammatory? J Thromb Thrombolysis [Internet]. 2020 6th July [cited 2021 5th January]; 1-6.

[32]	Violi F, Pastori D, Cangemi R, Pignatelli P, Loffredo L. Hypercoagulation and Antithrombotic Treatment in Coronavirus 2019: A New Challenge. Thromb Haemost [Internet]. 2020 Jun 1 [cited 2021 Jan 5]; 120(6): 949-56.

[33]	Della Bona R, Valbusa A, La Malfa G, Giacobbe DR, Ameri P, Patroniti N, et al. Systemic fibrinolysis for acute pulmonary embolism complicating acute respiratory distress syndrome in severe COVID-19: a case series. Eur Hear J - Cardiovasc Pharmacother [Internet]. 2020 14th July [cited 2021 5th January]; Available from: https://academic.oup.com/ehjcvp/advance-article/doi/10.1093/ehjcvp/pvaa087/5871349.

[34]	Ali N. Relationship Between COVID-19 Infection and Liver Injury: A Review of Recent Data. Front Med [Internet]. 2020 21st July [cited 2021 5th January];7:458. Available from: https://www.frontiersin.org/article/10.3389/fmed.2020.00458/full.

[35]	Von Bartheld CS, Butowt R, Hagen MM. Prevalence of chemosensory dysfunction in COVID-19 patients: A systematic review and meta-analysis reveals significant ethnic differences [Internet]. Vol. 11, ACS Chemical Neuroscience. American Chemical Society; 2020 [cited 2021 5th January]. p. 2944-61.

[36]	Spyropoulos AC, Weitz JI. Hospitalized COVID-19 Patients and Venous Thromboembolism: A Perfect Storm [Internet]. Vol. 142, Circulation. Lippincott Williams and Wilkins; 2020 [cited 2021 5th January]. p. 129-32.

[37]	Poissy J, Goutay J, Caplan M, Parmentier E, Duburcq T, Lassalle F, et al. Pulmonary Embolism in Patients with COVID-19: Awareness of an Increased Prevalence [Internet]. Vol. 142, Circulation. Lippincott Williams and Wilkins; 2020 [cited 2021 5th January]. p. 184-6.

[38]	Pesavento R, Ceccato D, Pasquetto G, Monticelli J, Leone L, Frigo A, et al. The hazard of (sub)therapeutic doses of anticoagulants in non-critically ill patients with Covid-19: The Padua province experience. J Thromb Haemost [Internet]. 2020 Oct 24 [cited 2021 Jan 5]; 18(10): 2629-35.

[39]	Brouns SH, Brüggemann R, Linkens AEMJH, Magdelijns FJ, Joosten H, Heijnen R, et al. Mortality and the Use of Antithrombotic Therapies Among Nursing Home Residents with <scp>COVID</scp> -19. J Am Geriatr Soc [Internet]. 2020 Aug 21 [cited 2021 Jan 5]; 68(8): 1647-52.

[40]	Killerby ME, Link-Gelles R, Haight SC, Schrodt CA, England L, Gomes DJ, et al. Characteristics Associated with Hospitalization Among Patients with COVID-19 — Metropolitan Atlanta, Georgia, March–April 2020. MMWR Morb Mortal Wkly Rep [Internet]. 2020 Jun 26 [cited 2021 Jan 5]; 69(25): 790-4.