Thrombin Generation in Patients with Coronavirus Disease 2019
Marco Benati, Gian Luca Salvagno, Simone De Nitto, Matteo Gelati, Barbara Lavorgna, Cristiano Fava, Pietro Minuz, Giuseppe Lippi
Abstract
Several lines of evidence garnered so far attest that coronavirus disease 2019 (COVID-19) is associated with a remarkably high rate of thrombotic events.[1] Di Minno et al recently published the results of a critical literature review and meta-analysis, including 20 studies and totaling 1988 COVID-19 patients,[2] which revealed that the weighted mean prevalence of venous thromboembolism (VTE), deep vein thrombosis (DVT), and pulmonary embolism (PE) was as high as 31.3% (95% confidence interval [95% CI], 24.3–39.2%), 19.8% (95% CI: 10.5–34.0%), and 18.9% (95% CI: 14.4–24.3%), respectively. The presenting characteristics and outcomes of 455 patients with COVID-19 who developed VTE (83% PE and 17% isolated DVT, respectively) during hospitalization have also been recently described by Fernández-Capitán et al.[3] Interestingly, these patients had a median age of 65 years and most (i.e., over 70%) were male. The most frequent comorbidity was hypertension (42%), followed by diabetes (20%), chronic pulmonary disorders (10%), coronary artery disease (6%), and 4% were active smokers. The vast majority of these patients were immobilized (nearly 80%), while 4% were also diagnosed as having active cancer. Positive personal history for previous episodes of VTE was only present in less than 4% of all these patients. Irrespective of the high likelihood of developing VTE, DVT, PE and even in situ pulmonary thrombosis,[4] COVID-19 patients seem to carry also a considerable enhanced risk of arterial thrombosis, as recently emphasized by Boonyawat et al.[5] These authors performed a comprehensive meta-analysis, including 36 studies, and reporting that the incidence of arterial thromboembolism in COVID-19 was as around 3% in intensive care unit (ICU) settings. In another recent meta-analysis, published by Kunutsor and Laukkanen,[6] the incidence of myocardial infarction, ischemic stroke, and systemic arterial embolism was found to be comprised between 1.6% and 3.3%.