Thrombotic and Hypercoagulability Complications of COVID-19: An Update

Figures & data

Figure 1 Schematic representation of SARS-CoV-2 structure.

Figure 2 Activation of the spike protein by TMPRSS2 at (or close to) the cell surface, leading to fusion of the viral membrane with the plasma membrane.

Table 1 Incidence of Thrombotic Complications Among COVID-19 Patients

Author	Number of Subjects, N	Incidence of Thrombotic Event	Type of Thrombotic Event
Jenner et al^Citation17	2,928	90.3% experienced thrombotic complications (34% of ICU patients 56.3% non-ICU patients)	Deep vein thrombosis (DVT) reported (16.1% of ICU patients) Pulmonary embolism (12.6% of ICU patients) Venous thrombosis (56.3% routine screening)
Chen et al^Citation56	88	46%	Deep vein thrombosis
Shah et al^Citation57	187	N=81 (43.3%)	Pulmonary embolism (22.5%) Deep vein thrombosis (11.8%) Arterial complications (13.4%)
Gibson et al^Citation58	72	N=12 (16.7%)	Lower extremity of deep vein thrombosis
Monfardini et al^Citation59	34	N=26 (76%)	Pulmonary thromboembolism
Avruscio et al^Citation60	85 (41 critical cases)	N=43 (50.6%)	Pulmonary embolism (9.8%) Deep vein thrombosis (42.4%) Superficial vein thrombosis (3.5%)
Al-Samkari et al^Citation61	400 (144 critically ill)	N=38	Venous thromboembolism Arterial thrombosis
Demelo-Rodriguez et al^Citation62	156	N=23	Deep vein thrombosis
Piazza et al^Citation63	1,114	N=66	Venous thromboembolic event (4.6%) Deep vein thrombosis (3.5%) Pulmonary embolism (0.7%) Disseminated intravascular coagulation (1.3%)

Figure 3 Pathogenesis of thrombotic complications of COVID-19. SARS-CoV2 infection induces endothelial damage triggering endothelial release of cytokines, increasing capillary permeability. PAMPs and DAMPs induced activation of neutrophils, and macrophages results in localized production of cytokines, procoagulants, and complement activation, leading to further endothelial damage and tissue factor release. Endothelial damage exposes collagen and other prothrombotic mediators leading to thrombus formation.

Notes: Adapted from Brosnahan SB, Jonkman AH, Kugler MC, Munger JS, Kaufman DA. COVID-19 and Respiratory System Disorders: Current Knowledge, Future Clinical and Translational Research Questions. Arterioscler Thromb Vasc Biol. 2020;40(11):2586–2597.⁶⁴ © 2020 The Authors. Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/legalcode). https://www.ahajournals.org/doi/pdf/10.1161/ATVBAHA.120.314515?download=true.

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Brosnahan SB, Jonkman AH, Kugler MC, Munger JS, Kaufman DA. COVID-19 and respiratory system disorders: current knowledge, future clinical and translational research questions. Arterioscler Thromb Vasc Biol. 2020;40(11):2586–2597. doi:10.1161/ATVBAHA.120.314515

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