The mechanistic basis linking cytokine storm to thrombosis in COVID-19
Adam J. Wolf, Faria Khimani, Braian Yoon, Coltin Gerhart, Dakota Endsley, Anish Ray, Angelito F. Yango, Stuart D. Flynn, Gregory Y.H. Lip, Stevan A. Gonzalez, Mohanakrishnan Sathyamoorthy
Abstract
It is now well established that infection with SARS-CoV-2 resulting in COVID-19 disease includes a severely symptomatic subset of patients in whom an aggressive and/or dysregulated host immune response leads to cytokine storm syndrome (CSS) that may be further complicated by thrombotic events, contributing to the severe morbidity and mortality observed in COVID-19. This review provides a brief overview of cytokine storm in COVID-19, and then presents a mechanistic discussion of how cytokine storm affects integrated pathways in thrombosis involving the endothelium, platelets, the coagulation cascade, eicosanoids, auto-antibody mediated thrombosis, and the fibrinolytic system.