Understanding the Pathology
· Researchers from the Department of Health & Exercise Science at Appalachian State University analyze the vascular impact of SARS-CoV-2 on 20 healthy young adults 3-4 weeks post-infection by doppler ultrasound of arterial blood flow in the upper and lower extremities (markers of vascular function) and pulse wave velocity (indicator of arterial stiffness). Results demonstrated that brachial artery flow-mediated dilation (FMD) was 6% lower after COVID-19 infection, which is clinically significant because each 1% decrease in FMD is associated with a 13% higher risk of cardiovascular events, suggesting that systemic vascular dysfunction and arterial stiffness may be a potential mechanism of COVID-19 vasculopathy.
Management
· A single-center observational cohort study from Turin, Italy analyzed coagulopathy in 36 hospitalized pediatric patients (ages birth to 21 years) with COVID-19 (n=30) and Multisystem Inflammatory Syndrome in Children (MIS-C) (n=6) and found that D-dimer values were not useful in predicting disease severity. Significant differences between D-dimer and CRP values were observed between COVID-19 and MIS-C patients, however there was no difference in coagulopathy incidence in these groups (as measured by fibrinogen levels). They recommend against universal pharmacologic prophylaxis in pediatric COVID-19 patients except in cases of multiple concurrent pro-thrombotic risk factors such as obesity, active malignancy, and sickle cell disease.
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