Hypercoagulation and Antithrombotic Treatment in Coronavirus 2019: A New Challenge
Thrombosis and haemostasis. 2020
The novel coronavirus 2019 (COVID-19) is clinically characterized by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for a high number of patients needing mechanical ventilation or intensive care units treatment and for the elevated mortality risk. A link between COVID-19 and multiorgan failure may be dependent on the fact that most COVID-19 patients are complicated by pneumonia, which is known to be associated with early changes of clotting and platelet activation and artery dysfunction; these changes may implicate in thrombotic-related events such as myocardial infarction and ischemic stroke. Recent data showed that myocardial injury compatible with coronary ischemia may be detectable in SARS-CoV-2 patients and laboratory data exploring clotting system suggest the presence of a hypercoagulation state. Thus, we performed a systematic review of COVID-19 literature reporting measures of clotting activation to assess if changes are detectable in this setting and their relationship with clinical severity. Furthermore, we discussed the biologic plausibility of the thrombotic risk in SARS-CoV-2 and the potential use of an antithrombotic treatment.
Thrombopoietin receptor agonists and risk of portal vein thrombosis in patients with liver disease and thrombocytopenia: A meta-analysis
Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 2018;51((1):):24-27
BACKGROUND Treatment of thrombocytopenia with thrombopoietin receptor agonists (TPORAs) seems to be associated with portal vein thrombosis (PVT) in patients with chronic liver disease (CLD). We performed a meta-analysis of the trials carried out in this clinical setting to assess if such association is detectable. METHODS We performed a meta-analysis with studies that compared the effect of TPORAS vs placebo in patients with CLD and thrombocytopenia. RESULTS Four studies, including 1953 patients, reported the incidence of PVT in patients with CLD and thrombocytopenia treated with TPORAs or placebo. No significant difference was found for incidence of PVT in patients treated with TPORAs compared with placebo (O.R.: 2.8; 95% C.I., 0.97-8.16; p=0.055). A significant association between PVT and TPORAs was observed only in patients treated with eltrombopag (O.R.: 3.8; 95% C.I., 1.14-13.2; p=0.03). Three studies, including 514 patients who were undergoing an elective invasive procedure, analyzed the incidence of PVT in TPORAs-treated patients with CLD and thrombocytopenia; no significant difference was found for incidence of PVT in patients treated with TPORAs compared with placebo (O.R.: 2.6; 95% C.I., 0.6-11.6; p=0.212). A significant difference was found for incidence of arterial and venous thrombo-embolic events in CLD patients treated with eltrombopag compared with placebo-treated patients (O.R.: 3.4; 95% C.I., 1.5-7.7; p=0.003). CONCLUSION The results of this meta-analysis show that TPORAs are not associated with PVT in CLD patients even in the case of surgical procedure. PVT risk seems to be associated only with eltrombopag use.