Review Articles
Vol. 13 No. 1 (2021): Mediterranean Journal of Hematology and Infectious Diseases, Volume 13, 2021
THE PROTHROMBOTIC STATE ASSOCIATED WITH SARS-COV-2 INFECTION: PATHOPHYSIOLOGICAL ASPECTS
COVID and Thrombosis
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: June 28, 2021
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Severe coronavirus disease-2019 (COVID-19) is frequently associated with microvascular thrombosis, especially in the lung, or macrovascular thrombosis, mainly venous thromboembolism, that significantly contribute to the mortality burden of the disease. COVID-19 patients also exhibit distinctive laboratory abnormalities that are compatible with a prothrombotic state. The key event underlying COVID-19-associated thrombotic complications is an excessive host inflammatory response to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection generating multiple inflammatory mediators, mainly cytokines and complement activation products. The latter, along with the virus itself, the increased levels of angiotensin II and hypoxia, drive the major cellular changes promoting thrombosis, which include: (1) aberrant expression of tissue factor by activated alveolar epithelial cells, monocytes-macrophages and neutrophils, and production of other prothrombotic factors by activated endothelial cells (ECs) and platelets; (2) reduced expression of physiological anticoagulants by dysfunctional ECs, and (3) suppression of fibrinolysis by the endothelial overproduction of plasminogen activator inhibitor-1 and, likely, by heightened thrombin-mediated activation of thrombin-activatable fibrinolysis inhibitor. Moreover, neutrophils and other cells, upon activation or death, release nuclear materials which are endowed with potent prothrombotic properties. The ensuing thrombosis significantly contributes to lung injury and, in most severe COVID-19 patients, to multiple organ dysfunction. Insights into the pathogenesis of COVID-19-associated thrombosis may have implications for the development of new diagnostic and therapeutic tools.
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How to Cite
“THE PROTHROMBOTIC STATE ASSOCIATED WITH SARS-COV-2 INFECTION: PATHOPHYSIOLOGICAL ASPECTS: COVID and Thrombosis” (2021) Mediterranean Journal of Hematology and Infectious Diseases, 13(1), p. e2021045. doi:10.4084/MJHID.2021.045.
Copyright (c) 2021 Nicola Semeraro, Prof. Mario Colucci
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