Covid-19 y eventos tromboticos: epidemiología y etiopatogenia, revisión sistemática

Abstract

The coronavirus disease 2019 (COVID-19) pandemic constitutes an alarm situation in current evolution, with abundant research and constant surveillance, its epidemiological behavior and its underlying mechanisms are increasingly described in greater detail. The objective of this review is to evaluate the epidemiological aspects of thrombotic events (TE) in the context of COVID-19 and review the possible related pathophysiological mechanisms. A systematic bibliographic search of articles included in the PubMed, Scopus, Cochrane, Web of Science and Embase databases was carried out. Thirty articles were included in the review and quality assessment tools were used. One of the main points of discussion has focused on the inflammatory state produced by the infection, which has been correlated with hematological alterations that lead to a prothrombotic state. This could influence the multisystem involvement of the clinical picture in the most severe cases. Hospitalized patients with COVID-19 are at considerably increased risk of developing venous and arterial ET. The presence of ET during the in-hospital evolution has been correlated with higher mortality, forcing the implementation of prophylactic anticoagulant therapy to be considered. This therapeutic decision can be based on laboratory parameters such as serum levels of D-dimer. Although the mechanisms that cause the coagulopathy of COVID-19 have not been fully explained, it is presumed that the endothelial dysfunction and the state of hyperinflammation play a vital role.