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COVID-19 and Venous Thromboembolism
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COVID-19 and Venous Thromboembolism

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: closed (15 March 2022) | Viewed by 15772

Special Issue Editor

Dr. Luca Costanzo

E-Mail Website
Guest Editor
Unit of Angiology, Cardio-Thoraco-Vascular Department, Policlinico G. Rodolico - San Marco, University of Catania, Catania, Italy
Interests: atherosclerosis; vascular medicine; doppler ultrasonography; atherosclerotic vascular diseases; peripheral vascular diseases; phlebology; carotid artery diseases; angiology; capillaroscopy

Special Issue Information

Dear Colleagues,

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 has become a global concern, having a universal impact on humanity. It has been established that COVID-19 may predispose patients to thrombotic events with severe impact on their prognosis. The activation of the coagulation system with thromboembolic manifestations, including deep vein thrombosis, pulmonary embolism, arterial thrombotic events, and disseminated intravascular coagulopathy (DIC), has been described in several stage of COVID-19 disease. A favorable outcome has been reported with the use of heparin in COVID-19 patients, especially in those with markedly high D-dimer levels or with sepsis-induced coagulopathy. Conversely, little is known about the role of fondaparinux and direct oral anti-coagulants (DOACs). This Special Issue of the Journal of Clinical Medicine focuses on the update of mechanism of coagulation impairment, vascular manifestations, and therapeutic antithrombotic strategies/approaches.

Dr. Luca Costanzo
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • COVID-19
  • SARS-CoV-2
  • Thrombosis
  • Inflammation
  • Coagulopathy
  • D-Dimer
  • Low-molecular-weight heparin
  • Aspirin
  • DOAC
  • Vaccine

Published Papers (6 papers)

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Editorial

Jump to: Research, Review

3 pages, 197 KiB  
Editorial
Special Issue “COVID-19 and Venous Thromboembolism”
by Luca Costanzo
J. Clin. Med. 2022, 11(13), 3822; https://doi.org/10.3390/jcm11133822 - 01 Jul 2022
Viewed by 927
Abstract
In the last two years, the new coronavirus has afflicted the whole world causing a pandemic burdened by high morbidity and mortality [...] Full article
(This article belongs to the Special Issue COVID-19 and Venous Thromboembolism)

Research

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12 pages, 1312 KiB  
Article
Elderly Population with COVID-19 and the Accuracy of Clinical Scales and D-Dimer for Pulmonary Embolism: The OCTA-COVID Study
by Maribel Quezada-Feijoo, Mónica Ramos, Isabel Lozano-Montoya, Mónica Sarró, Verónica Cabo Muiños, Rocío Ayala, Francisco J. Gómez-Pavón and Rocío Toro
J. Clin. Med. 2021, 10(22), 5433; https://doi.org/10.3390/jcm10225433 - 20 Nov 2021
Cited by 5 | Viewed by 2327
Abstract
Background: Elderly COVID-19 patients have a high risk of pulmonary embolism (PE), but factors that predict PE are unknown in this population. This study assessed the Wells and revised Geneva scoring systems as predictors of PE and their relationships with D-dimer (DD) in [...] Read more.
Background: Elderly COVID-19 patients have a high risk of pulmonary embolism (PE), but factors that predict PE are unknown in this population. This study assessed the Wells and revised Geneva scoring systems as predictors of PE and their relationships with D-dimer (DD) in this population. Methods: This was a longitudinal, observational study that included patients ≥75 years old with COVID-19 and suspected PE. The performances of the Wells score, revised Geneva score and DD levels were assessed. The combinations of the DD level and the clinical scales were evaluated using positive rules for higher specificity. Results: Among 305 patients included in the OCTA-COVID study cohort, 50 had suspected PE based on computed tomography pulmonary arteriography (CTPA), and the prevalence was 5.6%. The frequencies of PE in the low-, intermediate- and high-probability categories were 5.9%, 88.2% and 5.9% for the Geneva model and 35.3%, 58.8% and 5.9% for the Wells model, respectively. The DD median was higher in the PE group (4.33 mg/L; interquartile range (IQR) 2.40–7.17) than in the no PE group (1.39 mg/L; IQR 1.01–2.75) (p < 0.001). The area under the curve (AUC) for DD was 0.789 (0.652–0.927). After changing the cutoff point for DD to 4.33 mg/L, the specificity increased from 42.5% to 93.9%. Conclusions: The cutoff point DD > 4.33 mg/L has an increased specificity, which can discriminate false positives. The addition of the DD and the clinical probability scales increases the specificity and negative predictive value, which helps to avoid unnecessary invasive tests in this population. Full article
(This article belongs to the Special Issue COVID-19 and Venous Thromboembolism)
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8 pages, 1066 KiB  
Communication
Neurosurgical Considerations Regarding Decompressive Craniectomy for Intracerebral Hemorrhage after SARS-CoV-2-Vaccination in Vaccine Induced Thrombotic Thrombocytopenia—VITT
by Florian Gessler, Ann Kristin Schmitz, Daniel Dubinski, Joshua D. Bernstock, Felix Lehmann, Sae-Yeon Won, Matthias Wittstock, Erdem Güresir, Alexis Hadjiathanasiou, Julian Zimmermann, Wolfgang Miesbach, Thomas Freiman, Hartmut Vatter and Patrick Schuss
J. Clin. Med. 2021, 10(13), 2777; https://doi.org/10.3390/jcm10132777 - 24 Jun 2021
Cited by 25 | Viewed by 4525
Abstract
Given the ongoing global SARS-CoV-2-vaccination efforts, clinical awareness needs to be raised regarding the possibility of an increased incidence of SARS-CoV-2-vaccine-related immune-mediated thrombocytopenia in patients with intracerebral hemorrhage (ICH) secondary to cerebral sinus and vein thrombosis (CVT) requiring (emergency) neurosurgical treatment in the [...] Read more.
Given the ongoing global SARS-CoV-2-vaccination efforts, clinical awareness needs to be raised regarding the possibility of an increased incidence of SARS-CoV-2-vaccine-related immune-mediated thrombocytopenia in patients with intracerebral hemorrhage (ICH) secondary to cerebral sinus and vein thrombosis (CVT) requiring (emergency) neurosurgical treatment in the context of vaccine-induced immune thrombotic thrombocytopenia (VITT). Only recently, an association of vaccinations and cerebral sinus and vein thrombosis has been described. In a number of cases, neurosurgical treatment is warranted for these patients and special considerations are warranted when addressing the perioperative coagulation. We, herein, describe the past management of patients with VITT and established a literature-guided algorithm for the treatment of patients when addressing the impaired coagulation in these patients. Increasing insights addressing the pathophysiology of SARS-CoV-2-vaccine-related immune-mediated thrombocytopenia guide physicians in developing an interdisciplinary algorithm taking into account the special considerations of this disease. Full article
(This article belongs to the Special Issue COVID-19 and Venous Thromboembolism)
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14 pages, 1176 KiB  
Article
Acute Pulmonary Embolism in Patients with and without COVID-19
by Antonin Trimaille, Anaïs Curtiaud, Kensuke Matsushita, Benjamin Marchandot, Jean-Jacques Von Hunolstein, Chisato Sato, Ian Leonard-Lorant, Laurent Sattler, Lelia Grunebaum, Mickaël Ohana, Patrick Ohlmann, Laurence Jesel and Olivier Morel
J. Clin. Med. 2021, 10(10), 2045; https://doi.org/10.3390/jcm10102045 - 11 May 2021
Cited by 3 | Viewed by 2535
Abstract
Introduction. Acute pulmonary embolism (APE) is a frequent condition in patients with COVID-19 and is associated with worse outcomes. Previous studies suggested an immunothrombosis instead of a thrombus embolism, but the precise mechanisms remain unknown. Objective. To assess the determinants and prognosis of [...] Read more.
Introduction. Acute pulmonary embolism (APE) is a frequent condition in patients with COVID-19 and is associated with worse outcomes. Previous studies suggested an immunothrombosis instead of a thrombus embolism, but the precise mechanisms remain unknown. Objective. To assess the determinants and prognosis of APE during COVID-19. Methods. We retrospectively included all consecutive patients with APE confirmed by computed tomography pulmonary angiography hospitalized at Strasbourg University Hospital from 1 March to 31 May 2019 and 1 March to 31 May 2020. A comprehensive set of clinical, biological, and imaging data during hospitalization was collected. The primary outcome was transfer to the intensive care unit (ICU). Results. APE was diagnosed in 140 patients: 59 (42.1%) with COVID-19, and 81 (57.9%) without COVID-19. A 812% reduction of non-COVID-19 related APE was registered during the 2020 period. COVID-19 patients showed a higher simplified pulmonary embolism severity index (sPESI) score (1.15 ± 0.76 vs. 0.83 ± 0.83, p = 0.019) and were more frequently transferred to the ICU (45.8% vs. 6.2%, p < 0.001). No difference regarding the most proximal thrombus localization, Qanadli score (8.1 ± 6.9 vs. 9.0 ± 7.4, p = 0.45), the proportion of subsegmental (10.2% vs. 11.1%, p = 0.86), and segmental pulmonary embolism (35.6% vs. 24.7%, p = 0.16) was evidenced between COVID-19 and non-COVID-19 APE. In COVID-19 patients with subsegmental or segmental APE, thrombus was, in all cases (27/27 patients), localized in areas with COVID-19-related lung injuries. Marked inflammatory and prothrombotic biological markers were associated with COVID-19 APE. Conclusions. APE patients with COVID-19 have a particular clinico–radiological and biological profile and a dismal prognosis. Our results emphasize the preeminent role of inflammation and a prothrombotic state in these patients. Full article
(This article belongs to the Special Issue COVID-19 and Venous Thromboembolism)
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Review

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13 pages, 1212 KiB  
Review
The Role of Heparin in COVID-19: An Update after Two Years of Pandemics
by Marco Mangiafico, Andrea Caff and Luca Costanzo
J. Clin. Med. 2022, 11(11), 3099; https://doi.org/10.3390/jcm11113099 - 30 May 2022
Cited by 14 | Viewed by 2103
Abstract
Coronavirus disease 2019 (COVID-19) is associated with an increased risk of venous thromboembolism (VTE) and coagulopathy, especially in critically ill patients. Endothelial damage induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is emerging as a crucial pathogenetic mechanism for the development of [...] Read more.
Coronavirus disease 2019 (COVID-19) is associated with an increased risk of venous thromboembolism (VTE) and coagulopathy, especially in critically ill patients. Endothelial damage induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is emerging as a crucial pathogenetic mechanism for the development of complications in an acute phase of the illness and for several postdischarge sequalae. Heparin has been shown to have a positive impact on COVID-19 due to its anticoagulant function. Moreover, several other biological actions of heparin were postulated: a potential anti-inflammatory and antiviral effect through the main protease (Mpro) and heparansulfate (HS) binding and a protection from the damage of vascular endothelial cells. In this paper, we reviewed available evidence on heparin treatment in COVID-19 acute illness and chronic sequalae, focusing on the difference between prophylactic and therapeutic dosage. Full article
(This article belongs to the Special Issue COVID-19 and Venous Thromboembolism)
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11 pages, 6682 KiB  
Review
Venous Thromboembolism in COVID-19 Compared to Non-COVID-19 Cohorts: A Systematic Review with Meta-Analysis
by Antonella Tufano, Domenico Rendina, Veronica Abate, Aniello Casoria, Annachiara Marra, Pasquale Buonanno, Ferruccio Galletti, Giovanni Di Minno, Giuseppe Servillo and Maria Vargas
J. Clin. Med. 2021, 10(21), 4925; https://doi.org/10.3390/jcm10214925 - 25 Oct 2021
Cited by 24 | Viewed by 2366
Abstract
Background: A high incidence of venous thromboembolism (VTE) is reported in hospitalized COVID-19 patients, in particular in patients admitted to the intensive care unit (ICU). In patients with respiratory tract infections, including influenza A (H1N1), many studies have demonstrated an increased incidence of [...] Read more.
Background: A high incidence of venous thromboembolism (VTE) is reported in hospitalized COVID-19 patients, in particular in patients admitted to the intensive care unit (ICU). In patients with respiratory tract infections, including influenza A (H1N1), many studies have demonstrated an increased incidence of thromboses, but evidence is lacking regarding the risk difference (RD) of the occurrence of VTE between COVID-19 and non-COVID-19 patients. Methods: In this systematic review with meta-analysis, we evaluated the RD of the occurrence of VTE, pulmonary embolism (PE), and deep venous thrombosis (DVT) between COVID-19 and other pulmonary infection cohorts, in particular H1N1, and in an ICU setting. We searched for all studies comparing COVID-19 vs. non-COVID-19 regarding VTE, PE, and DVT. Results: The systematic review included 12 studies and 1,013,495 patients. The RD for VTE in COVID-19 compared to non-COVID-19 patients was 0.06 (95% CI 0.11–0.25, p = 0.011, I2 = 97%), and 0.16 in ICU (95% CI 0.045–0.27, p = 0.006, I2 = 80%). The RD for PE between COVID-19 and non-COVID-19 patients was 0.03 (95% CI, 0.006–0.045, p = 0.01, I2 = 89%). The RD for PE between COVID-19 and non-COVID-19 patients was 0.021 in retrospective studies (95% CI 0.00–0.04, p = 0.048, I2 = 92%) and 0.11 in ICU studies (95% CI 0.06–0.16, p < 0.001, I2 = 0%). Conclusions: The growing awareness and understanding of a massive inflammatory response combined with a hypercoagulable state that predisposes patients to thrombosis in COVID-19, in particular in the ICU, may contribute to a more appropriate strategy of prevention and earlier detection of the thrombotic events. Full article
(This article belongs to the Special Issue COVID-19 and Venous Thromboembolism)
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