Reviews
Vol. 1 No. 3 (2022)
https://doi.org/10.4081/btvb.2022.48

A re-appraisal of thrombogenesis in COVID-19, seen as a multiple "Complex system"

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COVID-19, Complex System, Thrombogenesis
Received: 27 July 2022
Accepted: 5 September 2022
Published: 24 October 2022
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Authors

Sergio Coccheri
sergio.coccheri@gmail.com
University of Bologna, School of Medicine, Bologna, Italy; Arianna Foundation for Anticoagulation, Bologna, Italy.

The aim of this essay is to re-consider the peculiar type of thrombogenesis observed in severe cases of COVID-19 infection, focusing on the multiple interconnected networks involved, such as inflammation, blood coagulation, fibrinolysis, and immune responses. These linked mechanisms can be assimilated to the “Complex Systems” (CS), that play a capital role in various domains: from physics to chemistry, biology and medicine, to social and behavioral sciences. CS are characterized by eliciting variable responses: their final results can be contradictory and often unpredictable. In fact, in severe COVID-19 various outcomes can occur, such as macro- and micro-thrombosis, vasculitis, hemorrhage, hyper and hypo fibrinolysis, distorted inflammatory and immune response, and others. The insight supplied by the CS theory in understanding thrombogenesis in COVID-19 can be useful in several ways. It recalls the importance of a “holistic” view of multiple patterns of signs, symptoms and biomarkers; stresses the added value of global versus mechanistic tests, particularly in coagulation and fibrinolysis; suggests building up small trials of selected patients in a perspective of precision medicine; discourages passive transfer of therapeutic choices from non-COVID to COVID patients; and finally indicates that some treatments, as the anti-inflammatory and the anti-coagulant ones, should be initiated as early as possible, so to avoid worsening of the condition by repetitive feedback and shortcut mechanisms.

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1.
Coccheri S. A re-appraisal of thrombogenesis in COVID-19, seen as a multiple "Complex system". Bleeding Thromb Vascul Biol [Internet]. 2022 Oct. 24 [cited 2025 Sep. 6];1(3). Available from: https://www.btvb.org/btvb/article/view/48
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