COVID-19-Associated Hyperviscosity: A Potential Link between Inflammation and Thrombophilia

4 Pages Posted: 13 May 2020

See all articles by Cheryl Maier

Cheryl Maier

Emory University School of Medicine

Alexander D. Truong

Emory University School of Medicine

Sara Auld

Emory University School of Medicine

Derek Polly

Emory Healthcare - EUHM; Mercer University College of Pharmacy; Emory University School of Medicine

Christin-Lauren Tanksley

Emory University School of Medicine

Alexander Duncan

Emory University School of Medicine

Date Written: April 25, 2020

Abstract

Although COVID-19 begins as a respiratory pneumonia, we are now discovering it causes an intense inflammatory response accompanied by systemic microangiopathy. In reflecting on Virchow’s triad, we considered the possibility that extreme elevation in acute phase response proteins like fibrinogen may result in hyperviscosity, a known cause of endothelial damage and resultant thrombosis. We found elevations in plasma viscosity in all 15 COVID-19 patients tested to date. Notably, the patients with the highest plasma viscosities experienced thrombotic complications despite receiving therapeutic anticoagulation. Plasma viscosity correlated strongly with illness severity (Pearson's r = 0.841, p <0.001). Given the growing evidence of thrombotic complications associated with COVID-19, the role of hyperviscosity in disease pathogenesis should be examined more widely. Therapeutic plasma exchange is a mainstay of treatment for immunoglobulin-related hyperviscosity, where symptomatic hyperviscosity is considered a medical emergency. Study of its use in critically ill patients with COVID-19 who have thrombotic complications despite therapeutic anticoagulation is urgently needed.

Note: Ethical Statement: This work was carried out ethically in accordance with Institutional Review Boardapproval.

Funding: There is no funding sourceto disclose

Conflict of Interest: The authors have nothing to disclose.

Keywords: COVID-19

Suggested Citation

Maier, Cheryl and Truong, Alexander D. and Auld, Sara and Polly, Derek and Tanksley, Christin-Lauren and Duncan, Alexander, COVID-19-Associated Hyperviscosity: A Potential Link between Inflammation and Thrombophilia (April 25, 2020). Available at SSRN: https://ssrn.com/abstract=3598209 or http://dx.doi.org/10.2139/ssrn.3598209

Cheryl Maier (Contact Author)

Emory University School of Medicine ( email )

1364 Clifton Rd. NE
Atlanta, GA 30322
United States

Alexander D. Truong

Emory University School of Medicine ( email )

1364 Clifton Rd. NE
Atlanta, GA 30322
United States

Sara Auld

Emory University School of Medicine ( email )

1364 Clifton Rd. NE
Atlanta, GA 30322
United States

Derek Polly

Emory Healthcare - EUHM

550 Peachtree St NE
Atlanta, GA 30308
United States

Mercer University College of Pharmacy ( email )

3001 Mercer University Drive
DV-181
Atlanta, GA 30341
United States

Emory University School of Medicine ( email )

1364 Clifton Rd. NE
Atlanta, GA 30322
United States

Christin-Lauren Tanksley

Emory University School of Medicine ( email )

1364 Clifton Rd. NE
Atlanta, GA 30322
United States

Alexander Duncan

Emory University School of Medicine ( email )

1364 Clifton Rd. NE
Atlanta, GA 30322
United States

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