Emerging evidence of a COVID-19 thrombotic syndrome has treatment implications.

Abstract

Reports of widespread thromboses and disseminated intravascular coagulation (DIC) in patients with coronavirus disease 19 (COVID-19) have been rapidly increasing in number. Key features of this disorder include a lack of bleeding risk, only mildly low platelet counts, elevated plasma fibrinogen levels, and detection of both severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and complement components in regions of thrombotic microangiopathy (TMA). This disorder is not typical DIC. Rather, it might be more similar to complement-mediated TMA syndromes, which are well known to rheumatologists who care for patients with severe systemic lupus erythematosus or catastrophic antiphospholipid syndrome. This perspective has critical implications for treatment. Anticoagulation and antiviral agents are standard treatments for DIC but are gravely insufficient for any of the TMA disorders that involve disorders of complement. Mediators of TMA syndromes overlap with those released in cytokine storm, suggesting close connections between ineffective immune responses to SARS-CoV-2, severe pneumonia and life-threatening microangiopathy.

• Authors: Joan T Merrill, Doruk Erkan, Jerald Winakur, Judith A James
• Journal: Nature reviews. Rheumatology (Nat Rev Rheumatol) Vol. 16 Issue 10 Pg. 581-589 (10 2020) ISSN: 1759-4804 [Electronic] United States
• PMID: 32733003 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Review)

Chemical References

• Anticoagulants
• Antiviral Agents
• Cytokines
• Immunoglobulins, Intravenous
• Immunosuppressive Agents
• Fibrinogen
• Complement System Proteins

Topics

• Anticoagulants (therapeutic use)
• Antiviral Agents (therapeutic use)
• Betacoronavirus (immunology)
• COVID-19
• Complement System Proteins (immunology)
• Coronavirus Infections (complications, epidemiology, immunology, virology)
• Cytokines (immunology)
• Disseminated Intravascular Coagulation (drug therapy, immunology, pathology, virology)
• Fibrinogen (analysis)
• Humans
• Immunoglobulins, Intravenous (therapeutic use)
• Immunosuppressive Agents (therapeutic use)
• Pandemics
• Plasma Exchange (methods)
• Platelet Count (methods)
• Pneumonia, Viral (complications, epidemiology, immunology, virology)
• Risk Factors
• SARS-CoV-2
• Thrombosis (drug therapy, immunology, pathology, virology)
• Thrombotic Microangiopathies (drug therapy, immunology, pathology, virology)