COVID-19 and Coronary Stent Thrombosis: A Systematic Review of Literature

Coronavirus Disease-19 (COVID-19) is a worldwide pandemic and it has created many difficulties in providing medical care due to the various multi-organ disease manifestations caused by the virus. In this paper we explore cases of stent thrombosis which occurred in patients who were infected with COVID-19 and discuss its role in potentiating this complication through the variety of mechanisms in which it creates a prothrombotic state. Stent thrombosis is described as the thrombotic occlusion of a coronary stent. The incidence of this complication has decreased considerably (from 16% to 0.7%) since the advent of antiplatelet therapy and drug eluting stents. In this systematic review, 8 papers were found which detailed 11 patients who were infected with COVID-19 and suffered a stent thrombosis. Data from these cases were tabulated and analyzed. The ages of the patient’s ranged from 49-81 years and quite interestingly the time between the time of stent placement and occurrence of stent thrombosis had great variation between patients, with some occurring within minutes of stent placement and others occurring in a stent that was placed many years ago. 91% of the patients had ST-segment elevation myocardial infarction (STEMI) for presentation of stent thrombosis and 9% had a non-ST segment myocardial infarction (NSTEMI) on presentation. Therapy mainly involved antiplatelet therapy and Percutaneous Coronary Angioplasty with new stent placement. Despite this mortality rate among the cases present was quite high at 45%, with some patients dying as a result of COVID-19 related complications. Through various literature reviews, we have found that COVID-19 contributes in creating a prothrombotic state through various inflammatory mediated mechanisms. This prothrombotic state is a major risk factor towards stent thrombosis and we recommend that physicians be aware of this potentially fatal complication in COVID-19 patients.