SARS-CoV-2 infection and thrombotic complications: a narrative review

J Thromb Thrombolysis. 2021 Jul;52(1):111-123. doi: 10.1007/s11239-020-02374-3. Epub 2021 Jan 15.

Abstract

The current, global situation regarding the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic and its potentially devastating clinical manifestations, i.e. coronavirus disease 2019 (COVID-19), took the world by storm, as millions of people have been infected worldwide and more than 1,600,000 patients have succumbed. Infection induced by various respiratory viruses may lead to thrombotic complications. Infection-elicited thrombosis may involve a repertoire of distinct, yet interconnected pathophysiological mechanisms, implicating a hyperinflammatory response, platelet activation and triggering of the coagulation cascade. In the present review, we present current knowledge on the pathophysiological mechanisms that may underlie thrombotic complications in SARS-CoV-2 infection. Furthermore, we provide clinical data regarding the incidence rate of thrombotic events in several viral respiratory infections that cause acute respiratory distress syndrome, including SARS-CoV-2 infection and finally we summarize current recommendations concerning thromboprophylaxis and antithrombotic therapy in patients with thrombotic complications related to SARS-CoV-2 infection.

Keywords: Acute respiratory distress syndrome; Antithrombotic therapy; COVID-19; Endothelium; Inflammation; Respiratory viruses; SARS-CoV-2; Thrombosis; Venous thromboembolism.

Publication types

  • Review

MeSH terms

  • Animals
  • Anticoagulants / therapeutic use
  • Blood Coagulation* / drug effects
  • COVID-19 / blood*
  • COVID-19 / epidemiology
  • COVID-19 / virology
  • COVID-19 Drug Treatment
  • Fibrinolytic Agents / therapeutic use
  • Host-Pathogen Interactions
  • Humans
  • Incidence
  • Prognosis
  • Risk Assessment
  • Risk Factors
  • SARS-CoV-2 / pathogenicity*
  • Thrombosis / blood*
  • Thrombosis / epidemiology
  • Thrombosis / prevention & control
  • Thrombosis / virology

Substances

  • Anticoagulants
  • Fibrinolytic Agents