Lopes Leilani A, Agrawal Devendra K
Western University of Health Sciences, College of Osteopathic Medicine of the Pacific - Northwest, Lebanon.
Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Pomona, CA.
Cardiol Cardiovasc Med. 2023;7(2):123-128. doi: 10.26502/fccm.92920317. Epub 2023 Apr 20.
SARS-CoV-2 is a +ssRNA helical coronavirus responsible for the global pandemic caused by coronavirus disease 19 (COVID-19). Classical clinical symptoms from primary COVID-19 when symptomatic include cough, fever, pneumonia or even ARDS; however, they are limited primarily to the respiratory system. Long-COVID-19 sequalae is responsible for many pathologies in almost every organ system and may be present in up to 30% of patients who have developed COVID-19. Our review focuses on how long-COVID-19 (3 -24 weeks after primary symptoms) may lead to an increased risk for stroke and thromboembolism. Patients who were found to be primarily at risk for thrombotic events included critically ill and immunocompromised patients. Additional risk factors for thromboembolism and stroke included diabetes, hypertension, respiratory and cardiovascular disease, and obesity. The etiology of how long-COVID-19 leads to a hypercoagulable state are yet to be definitively elucidated. However, anti-phospholipid antibodies and elevated D-dimer are present in many patients who develop thromboembolism. In addition, chronic upregulation and exhaustion of the immune system may lead to a pro-inflammatory and hypercoagulable state, increasing the likelihood for induction of thromboembolism or stroke. This article provides an up-to-date review on the proposed etiologies for thromboembolism and stroke in patients with long-COVID-19 and to assist health care providers in examining patients who may be at a higher risk for developing these pathologies.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）是一种正链单股RNA螺旋状冠状病毒，可引发由冠状病毒病19（COVID-19）导致的全球大流行。有症状的原发性COVID-19的典型临床症状包括咳嗽、发热、肺炎甚至急性呼吸窘迫综合征；然而，这些症状主要局限于呼吸系统。长期COVID-19后遗症会导致几乎每个器官系统出现多种病变，在感染COVID-19的患者中，高达30%的人可能会出现这些后遗症。我们的综述重点关注长期COVID-19（主要症状出现后3至24周）如何可能导致中风和血栓栓塞风险增加。被发现主要有血栓形成事件风险的患者包括重症患者和免疫功能低下患者。血栓栓塞和中风的其他风险因素包括糖尿病、高血压、呼吸系统和心血管疾病以及肥胖。长期COVID-19导致高凝状态的病因尚未完全阐明。然而，许多发生血栓栓塞的患者体内存在抗磷脂抗体和D-二聚体升高的情况。此外，免疫系统的慢性上调和耗竭可能导致促炎和高凝状态，增加引发血栓栓塞或中风的可能性。本文对长期COVID-患者血栓栓塞和中风的拟议病因进行了最新综述，以帮助医疗保健提供者检查可能有更高风险发生这些病变的患者。
