J Am Heart Assoc. 2020 Nov 24:e019650. doi: 10.1161/JAHA.120.019650. Online ahead of print.
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) which has posed a significant threat to global health. Although the infection is frequently asymptomatic or associated with mild symptoms, in a small proportion of patients it can produce an intense inflammatory and prothrombotic state that can lead to acute respiratory distress syndrome, multiple organ failure, and death. Angiotensin-converting enzyme 2 (ACE2), highly expressed in the respiratory system, has been identified as a functional receptor for SARS-CoV-2. Notably, ACE2 is also expressed in the cardiovascular system and there are multiple cardiovascular implications of COVID-19. Cardiovascular risk factors and cardiovascular disease have been associated with severe manifestations and poor prognosis in patients with COVID-19. Importantly, patients with COVID-19 may have thrombotic and coagulation abnormalities promoting a hypercoagulable state, resulting in an increased rate of thrombotic and thromboembolic events. This review will describe the pathophysiology of the cardiovascular involvement following infection by SARS-CoV-2, with a focus on thrombotic and thromboembolic manifestations and implications for antithrombotic management.