MicroCLOTS pathophysiology in COVID 19

Renzi, Samuele; Landoni, Giovanni; Zangrillo, Alberto; Ciceri, Fabio

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Korean J Intern Med > Accepted Articles

MicroCLOTS pathophysiology in COVID 19

Samuele Renzi^1,2

, Giovanni Landoni^2,3, Alberto Zangrillo^2,3, and Fabio Ciceri^3,4

¹Division of Hematology Oncology, The Hospital for Sick Children, Toronto, Canada
²Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
³Vita-Salute San Raffaele University, Milan, Italy
⁴Department of Hematology and Stem Cell Transplantation, IRCCS San Raffaele Scientific Institute, Milan Italy

Corresponding Author: Giovanni Landoni , Tel: +1-647-804-2507, Fax: +1-416-530-3032, Email: samuele.renzi@sickkids.ca

Received: July 3, 2020; Revised: July 13, 2020; Accepted: August 11, 2020.

Abstract

Severe acute respiratory syndrome coronavirus 2 ( SARS-CoV-2) is the novel coronavirus responsible for the ongoing pandemic. It is known that SARS-CoV-2 infects the host through the cell surface receptor of angiotensin-converting enzyme 2 (ACE2), which is expressed in multiple organs, and in the arterial and venous endothelial cells. We have recently proposed the use of the term MicroCLOTS ( Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome) to describe the unique type of ARDS seen in patients affected by SARS-COV-2. After a multidisciplinary assessment of more than 850 COVID-19 patients admitted to our Hospital with several bilateral pneumonia, we have collected evidences supporting a key role of vascular inflammation and microthrombosis in the pathophysiology of the multisystemic clinical manifestations that have been associated with COVID-19. There is now a general consensus on the recommendation of anticoagulation in patient with severe SARS-Cov2 infections, although the dose of the prophylaxis and even the choice between a prophylactic and a treatment regimen remains controversial. Randomized controlled trials are urgently needed to help clarifying the many therapeutic challenges associated with the management of SARS-Cov-2 patients.

Keywords: SARS-CoV-2 ; microCLOTS ; microthrombosis ; Vasculitis